disaster preparedness - ky chfs...q social security cards q financial records q passports q...
TRANSCRIPT
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Patient Resource Manual
Disaster Preparednessfor Persons with Chronic Disease
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TABLE OF CONTENTS
PREFACE
WHY PREPARE? ...........................................4
WHAT YOU NEED TO DO ...........................5 1.GetInformed............................................................................. 5 2.MakeaPlan................................................................................ 9 3.AssembleaDisasterSuppliesKit..................................... 10 4.MaintainYourPlan...............................................................13
IF DISASTER STRIKES ...............................14
ADDITIONAL RESOURCES .......................15 1.SourcesForEmergencyPreparednessInformation...15 2.CommunityEmergency/DisasterResourceForm..... 16 3.PersonalMedicalInformationForm............................... 17 4.EmergencyContactCards.................................................. 19 5.PetsandDisasters...................................................................20 6.TransferTrauma...................................................................... 21 7.StressReactions.......................................................................22 8.MedicalItemsNeeded..........................................................22 9.Dietary........................................................................................24
DISEASE SPECIFIC INFORMATION ..........26 1.Asthma,ChronicObstructivePulmonary Disease(COPD)andOtherLungDiseases....................26 2.Cancer........................................................................................ 31 3.DementiaandMemoryLoss..............................................34 4.Diabetes......................................................................................39 5.HeartDisease,HighBloodPressureandStroke..........43 6.KidneyDisease/Dialysis.......................................................50 7.Osteoporosis,ArthritisandBoneDiseases...................65 8.Parkinson’sDisease,Alzheimer’sDisease andOtherNeurologicalDisorders...................................70
PREFACEThismanualwaspreparedbyUniversityofLouisvilleHospitalwithagrantfromtheKentuckyDepartmentforPublicHealth.
Itisintendedforindividualswithchronicdisease,aswellasfamilymembersandcaretakersofthoseindividuals,topreparefordisasters.
ThispublicationwassupportedbyacooperativeagreementwiththeCDC.ItscontentsaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresenttheofficialviewsoftheCDC.
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Disasterplanningisessentialforeveryone.Thisisespeciallytrueforthemorethan90millionAmericansthatcurrentlylivewithchronicdiseases.Youmaybeabletoeasilymanageyourconditionnow,butduringadisaster,manyservicesyourelyonmaynotbeavailable.Yourconditionandalackoftheseservicesmakeyouveryvulnerableinadisaster.Ithasbeenfoundthatlackofaccesstoroutinehealthcareisaleadingcauseofdeathafterdisasters.Properdisasterplanningcanhelptolimityourvulnerability.
Therearemanythingstoconsiderwhenplanningforadisaster.Wherewillyou,yourfamily,yourfriendsorpersonalcareattendantsbewhenanemergencyordisasterstrikes?You,andthoseyoucareabout,couldbeanywhere–athome,work,schoolorintransit.Howwillyoufindeachother?Willyouknowyourlovedoneswillbesafe?Emergenciesanddisasterscanstrikequicklyandwithoutwarning.Theycanforceyoutoleaveyourneighborhoodorconfineyoutoyourhome.
Ifutilities(water,gas,electricityortelephones)werenotavailable,whatwouldyoudo?Localofficialsandreliefworkerswillbeonthesceneafteradisaster,buttheycannotreacheveryonerightaway.Youareinthebestpositiontoplanforyourownsafety.Why?Becauseyouarebestabletoknowyourabilitiesandpossibleneedsduringandafteranemergencyordisastersituation.Youcancopewithdisasterbypreparinginadvancewithyourfamilyandcareattendants.Knowingwhattodoisyourbestprotectionandyourresponsibility.
Theinformationinthismanualistohelpyouplanandpreparefordisastersituations.Agreatdealoftheinformationisgeneral,innature,andcanbeusefultoanyoneplanningfordisasterpreparedness.Thereisalsospecificinformationtohelpyouovercomethechallengesthatyourchronicdiseasepresentswhenpreparingfordisasters.Rememberthatstresscanaggravateanychroniccondition.Preparingnowcanhelptoreducestressshouldadisasteroccur.
WHY PREPARE?
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WHAT YOU NEED TO DO
�. Get InformedInorderforindividualstobeproperlyinformedaboutdisasterpreparednesstheyneedtogatherinformationfrommultiplesources.Thisisaccomplishedbycompletinganassessmentinthefollowingthreeareas:
•Personal •Household •Community
Personal AssessmentIndividualsshouldcompleteapersonalassessmentinordertoidentifytheirneedsduringandafteradisaster.Apersonalassessmentisespeciallyimportantforthosewithchronicdiseasebecauseoftheirincreasedvulnerabilityduringadisaster.
Twomainscenariostoconsiderare: •StayingIn •GettingOut
Staying In–whatindividualsneedtoconsideriftheyhavetoremainintheirhomesduringorfollowingadisaster.
DailyLiving:Itemsforpersonalcaresuchasbathing,groominganddressing;adaptivefeedingdevicessuchasspecialutensils
Lossofutilitiessuchaswaterorelectricity(Note:Most utility companies requireindividuals who are dependent upon electrically run medical equipment to registerwith them before a disaster occurs)
Mobility:Dealingwithdebrisinoraroundthehome;usingmobilityaidssuchasmotorizedormanualwheelchairs,walkers,canes,etc.
AdditionalSupplies:Obtaininggroceries,medicationsandmedicalsuppliesafterthedisasterkithasbeenexhausted
GettingHelp:Notifyingthepersonalsupportnetwork(thisconceptwillbediscussedingreaterdetaillaterinthismanual)
Getting Out–whatindividualsneedtoconsideriftheyhavetoleavetheirhomesduringorfollowingadisaster.
DailyLiving:Whatpersonalcareitemstotakealongsuchasbathing,groominganddressing;adaptivefeedingdevicessuchasspecialutensils
Mobility:Lossoftheabilitytousemobilityaids,suchasdamagetoramps;usingalternativeexitstogetout;lossordamagetotransportation,suchascarsorspeciallyequippedvehicles;seekingalternateformsoftransportationsuchaspublictransportationorambulanceservices
AdditionalSupplies:Obtaininggroceries,medicationsandmedicalsuppliesafterthedisasterkithasbeenexhausted
GettingHelp:Notifyingpersonalsupportnetworkoflocationandpossibleneeds;assistancewithevacuation(friends,family,firstandcommunityresponders)
SeekingShelter:Itispreferabletostaywithfamily,friendsoreveninahotel.
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Apublicsheltershouldbealastresort.Individualswithchronicdiseasemaynotbeabletoreceivecareataregularshelter.Somecommunitieshavespecialneedssheltersavailableforthosewithchronicdisease.Thesesheltersoftenrequireadvancedregistration.
Evenaspecialneedssheltermaynothavethecorrectmedicalsupplies.Individualsareencouragedtobringtheitemstheirconditionrequires.
Mostsheltersdonotallowpets,onlylicensedserviceanimals.Itisimportanttoidentifypetfriendlysheltersorboardingfacilitiesaheadoftime.
Household AssessmentTheActionChecklistisatoolthatcanbeusedtodeterminethegeneraldisasterpreparednessofahousehold.
Action Checklist: Items to Do Before a Disaster
Considerations for People with Disabilities Individualswithdisabilitiesorotherspecialneedsoftenhaveuniqueneedsthatrequiremoredetailedplanningintheeventofadisaster.Considerthefollowingactionsasyouprepare:
qLearnwhattodoincaseofpoweroutagesandpersonalinjuries.Knowhow toconnectandstartaback-uppowersupplyforessentialmedicalitems.
qConsidergettingamedicalalertsystem.Itwillallowyoutocallforhelpifyou cannotgettoaphoneinanemergency.Mostalertsystemsrequireaworking phoneline,sohaveaback-upplansuchasacellphoneorpager.
qIfyouuseanelectricwheelchairorscooter,haveamanualwheelchairforbackup.
qTeachthosewhomayneedtoassistyouinanemergencyhowtooperatenecessary items.Also,labelitemsandattachlaminatedinstructionsforeachitem’suse.
qStoreback-upitems(mobility,medical,etc.)atyourneighbor’shome,school oryourworkplace.
qArrangeformorethanonepersonfromyourpersonalsupportnetworktocheck onyouinanemergency,sothereisatleastoneback-upiftheprimaryperson yourelyonisunavailable.
qIfyouuseapersonalcareattendantfromanagency,checktoseeiftheagency hasspecialprovisionsforemergencies.Forexample,dotheyprovideservicesat anotherlocationshouldanevacuationbeordered?
qIfyouliveinanapartment,askthemanagementtoidentifyandmarkaccessible exitsandaccesstoallareasdesignatedforemergencyshelterorsaferooms.
qHaveacellphonewithanextrafully-chargedbattery.Ifyouareunabletogetoutofa building,youcanletsomeoneknowwhereyouareandguidethemtoyou.Keepthe numbersyoumayneedtocallwithyouifthe9-1-1emergencynumberisoverloaded.
qLearnaboutdevicesandothertechnologyavailable(PDAs,textradio,pagers,etc.) toassistyouinreceivingemergencyinstructionsandwarningsfromlocalofficials.
qBepreparedtoprovideclear,specificandconciseinstructionstorescuepersonnel. Practicegivingtheseinstructions(verbally,pre-printedphrases,wordboard,etc.) clearlyandquickly.
qPrepareyourpersonalsupportnetworktoassistyouwithanticipatedreactions andemotionsassociatedwithdisasterandtraumaticevents,suchasconfusion, agitation,fear,panicandanxiety.
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qYoudonothavetobetheonlyoneprepared.Encourageotherstobepreparedand considervolunteeringorworkingwithlocalauthoritiesondisabilityandother specialneedspreparednessefforts.
Utilities: qKnowhowandwhentoturnoffwater,gasandelectricityatthemainswitches orvalvesandsharethisinformationwithyourfamilyandcaregivers.
qKeepanytoolsyouwilluseneargasandwatershutoffvalves.
qTurnofftheutilitiesonlyifyoususpectdamagedlines,aleakoriflocalofficialsinstruct youtodoso.(Note:Gasshut-offprocedure–Aspartofthelearningprocess,donot actuallyturnoffthegas.Onlyaqualifiedprofessionalcanturnonthegasbackon.It mighttakeseveralweeksforaprofessionaltorespond.Inthemeantime,youwillrequire alternatesourcestoheatyourhome,makehotwaterandcook).
Fire Extinguisher: qBesureeveryoneknowshowtouseyourfireextinguishers(ABCtype)andwheretheyarelocated.
Smoke Alarms: qInstallsmokealarmsoneachlevelofyourhome,especiallynearthebedrooms.
qFollowlocalcodesandmanufacturer’sinstructionsaboutinstallationrequirements.
qInstallacarbonmonoxidealarminyourhome.
Insurance Coverage: qCheckifyouhaveadequateinsurancecoverage.Homeownersinsurancedoes notcoverflooddamage.Italsomaynotprovidefullcoverageforotherhazards.
qTalkwithyourinsuranceagentandmakesureyouhaveadequatecoverageto protectyourfamilyagainstfinancialloss.
First Aid/CPR & AED (Automated External Defibrillation):qTakeafirstaidandaCPR/AEDclass.RedCrosscoursescanaccommodate peoplewithdisabilities.Discussyourneedswhenregisteringfortheclasses.
Inventory Home Possessions:qMakearecordofyourpossessionstoassistwithclaimreimbursementincase oflossordamage.
qStorethisinformationinasafedepositboxorothersecure(flood/firesafe) locationtoensuretherecordssurviveadisaster.
qIncludephotographsorvideooftheinteriorandexteriorofyourhomeaswell ascars,boatsandrecreationalvehicles.
qHavephotosofdurablemedicalitemsandbesuretomakearecordofthe makeandmodelnumbersforeachitem.
qObtainprofessionalappraisalsofjewelry,collectibles,artworkorotheritemsthat maybedifficulttoevaluate.
qMakecopiesofreceiptsandcanceledchecksshowingthecostforvaluableitems.
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Vital Records and Documents:Thefollowingimportantdocumentsshouldbekeptinasafedepositboxorothersafelocation:
qBirthandmarriagecertificates qDeedsqSocialSecuritycards qFinancialrecordsqPassports qInsurancerecordsqWills qImmunizationrecords
Reduce Home Hazards: Inadisaster,ordinaryitemsinthehomecancauseinjuryanddamage.Takethesestepstoreduceyourrisk:
qKeeptheshut-offswitchforoxygenitemsnearyourbedorchair,soyou cangettoitquicklyifthereisafire.
qHaveaprofessionalrepairdefectiveelectricalwiringandleakygasconnections.
qPlacelarge,heavyobjectsonlowershelves,andhangpicturesandmirrors awayfrombeds.
qUsestrapsorotherrestraintstosecuretallcabinets,bookshelves,largeappliances (especiallywaterheater,furnace,andrefrigerator),mirrors,shelves,largepicture framesandlightfixturestowallstuds.
qRepaircracksinceilingsandfoundations.
qStoreweedkillers,pesticidesandflammableproductsawayfromheatsources.
qPlaceoilyragsorwasteincoveredmetalcansanddisposeofthemaccording tolocalregulations.
qHaveaprofessionalcleanandrepairchimneys,fluepipes,connectorsandgasvents.
Community AssessmentContactyourlocalemergencymanagementofficeorAmericanRedCrossChaptertogatherinformationyouwillneedtocreateaplan.
•CommunityHazards: ºAskaboutthespecifichazardsthatthreatenyourcommunity(e.g.,floods, tornados,earthquakes).
ºAskaboutyourriskfromthosehazards.
•CommunityDisasterPlans: ºLearnaboutcommunityresponseplans,evacuationplansand designatedemergencyshelters.
ºAskifyourcommunityhasashelterthatcanmeetyourspecialneeds. Ifso,findoutifyouneedtoregisterwithyourcommunity.Remember, mostpublicsheltersarenotsetuptocareforthosewithspecialneeds.
ºAskabouttheemergencyplansandproceduresthatexistinplaces youandyourfamilyspendtime,suchasplacesofemployment,schools andchildcarecenters.
ºIfyoudonotownavehicleordon’tdrive,findoutinadvancewhatyour community’splansareforevacuatingthosewithoutprivatetransportation.
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•CommunityWarningSystems: ºFindouthowlocalauthoritieswillwarnyouofadisaster.
ºHowwilltheyprovideinformationtoyouduringandafteradisaster?
ºLearnaboutNationalOceanicandAtmosphericAdministration(NOAA) WeatherRadioanditsalertingabilities.
•AssistancePrograms: ºAskaboutspecialassistanceprogramsavailableintheeventofanemergency. Manycommunitiesaskpeoplewithadisabilitytoregister,usuallywiththe localfire,policeoremergencymanagementoffice.Thisissoneededhelp canbeprovidedquicklyinanemergency.
ºLetyourpersonalcareattendantknowyouhaveregistered,andwithwhom.
ºIfyouareelectric-dependent,besuretoregisterwithyourlocalutilitycompany.
2. Make a PlanAdisastercandisruptyourprimaryemergencyplan.Itisimportantforyoutodevelopaback-upplantoensureyoursafety.
Create a Personal Support Network • Meet with Your Family/Personal Care Attendants/Building Manager: ºReviewtheinformationyougatheredaboutcommunityhazardsandemergencyplans.
• Choose an “Out-of-Town” Contact: ºAskanout-of-townfriendorrelativetobeyourcontact.Followingadisaster, familymembersshouldcallthispersonandtellthemwheretheyare.Everyone mustknowthecontact’sphonenumbers.Itisofteneasiertomakealongdistance callthanalocalcallfromadisasterarea.
• Decide Where to Meet: ºIfyouseparatefromhouseholdmembersinanemergency,haveaspecificmeetingspot.
ºChooseaplacerightoutsideyourhomeincaseofasuddenemergency,suchasafire.
ºChoosealocationoutsideyourneighborhoodincaseyoucannotreturnhome.
• Complete a Communication Plan: ºYourplanshouldincludecontactinformationforfamilymembers,members ofyoursupportnetwork,caregivers,workandschool.
ºYourplanshouldalsoincludeinformationforyourout-of-towncontact,meeting locations,emergencyservicesandtheNationalPoisonControlCenter(1-800-222-1222).
ºTeachyourchildrenhowtocalltheemergencyphonenumbersandwhenit isappropriatetodoso.
ºBesureeachfamilymemberhasacopyofyourcommunicationplanandpostitnear yourtelephoneforuseinanemergency.
• Escape Routes and Safe Places.Inafireorotheremergency,youmayneedtoleave atamoment’snotice. ºBereadytogetoutfast.Besureeveryoneinyourfamilyknowsthebestescape routesoutofyourhome.
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ºTheyalsoshouldknowwherethesafeplacesareinyourhomeforeachtype ofdisaster.Forexample,ifatornadoapproachesgotothebasementorthe lowestfloorofyourhomeoraninteriorroomorclosetwithnowindows.
ºUseablanksheetofpapertodrawthefloorplansofyourhome.Showthelocationof: •Doors •First-aidkits •Windows •Utilityshut-offpoints •Stairways •Fireextinguisher •Largefurniture •Importantpointsoutsidesuchasgarages,patios, •Disastersupplieskit stairways,elevators,drivewaysandporches •Smokealarms •Collapsibleladders
ºIndicateatleasttwoescaperoutesfromeachroom.
ºMarkaplaceoutsideofthehomewherehouseholdmembersand/oryour personalcareattendantshouldmeetincaseoffire.
ºIfyouorsomeoneinyourhouseholdusesawheelchair,makeexitsfrom yourhomewheelchair-accessible.
ºPracticeemergencyevacuationdrillsatleasttwiceayear.Alsopractice whenyouupdateyourescapeplan.
ºBesuretoincludefamilyand/oryourpersonalcareattendantinthedrills.
• Plan for Your Pets: ºTakeyourpetswithyouifyouleave.Forhealthreasons,emergencypublic sheltersdonotallowpets(otherthanserviceanimals).
ºPreparealistoffamily,friends,boardingfacilities,veterinariansand “pet-friendly”hotelsthatcouldshelteryourpetsinanemergency.
• Prepare for Different Hazards: ºIncludeinyourplanhowtoprepareforeachhazardthatcouldaffectyour localcommunityandhowtoprotectyourself.Forinstance,mostpeopleshelter inabasementwhenthereisatornadowarning,butmostbasementsarenot wheelchair-accessible.
ºDetermineinadvancewhatyouralternativeshelterwillbeandhowyou willgetthere.Otherhazards,suchasahomefire,willrequireyoutoleave.
ºMakesurebothprimaryandsecondaryexitsareaccessible.Beabletolocatethemby touchorfeel(sincelightsmaybeoutandthick,blacksmokemaymakeitveryhardtosee).
�. Assemble a Disaster Supplies KitSomeemergenciesmayrequireyoutoleaveatamoment’snotice.Othersmayrequireyoutoremainathome.Eitherwayyouprobablywillnothavetheopportunitytoshoporsearchforthesuppliesyouandyourfamilywillneed.Everyhouseholdshouldassembleadisastersupplieskitandkeepitup-to-date.
Adisastersupplieskitisacollectionofbasicitemsafamilywouldprobablyneedtostaysafeandbemorecomfortableduringandafteradisaster.Disastersupplieskititemsshouldbestoredinaportablecontainer(s)ascloseaspossibletotheexitdoor.Reviewthecontentsofyourkitatleastonceperyearorasyourfamily’sneedschange.Also,considerhavingemergencysuppliesineachvehicleandatyourplaceofemployment.Individualsshouldpreparetobeontheirownfor72-96hours.
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Basic disaster suppliesThefollowingitemsshouldbeincludedinyourbasicdisastersupplieskit:
• Three-daysupplyofnonperishablefoodandmanualcanopener.Seethedisease specificDietaryNeedssectionsformoreinformationbasedonyourchroniccondition
• Three-daysupplyofwater(onegallonofwaterperpersonperday).Your conditionmayrequiremorewater.Askyourphysicianaboutyourneeds.
• Portable,battery-poweredradioortelevisionandextrabatteries
• Flashlightandextrabatteries
• Firstaidkitandmanual
• Sanitationandhygieneitems(handsanitizer,moisttowelettesandtoiletpaper)
• Matchesinwaterproofcontainer
• Whistle
• Extraclothingandblankets
• Kitchenaccessoriesandcookingutensils
• Photocopiesofidentification,creditcardsandotherimportantpapers (e.g.,SocialSecuritycard,insurancepolicies,financialinformation)
• Cashandcoins
• Specialneedsitems(eyeglasses,contactlenssolution,hearingaidbatteries,etc.)
• Itemsforinfants,tools,petsupplies,amapofthelocalareaandotheritems tomeetyouruniquefamilyneeds
Thinkaboutyourclothingandbeddingneeds.Besuretoincludeonesetofthefollowingforeachperson:
• Changeofclothing
• Sturdyshoes
• Sleepingbagorwarmblanket
• Extraitemsforcoldweather(jackets,gloves,scarves,boots,etc.)
• Extraitemsforwarmweather(sunscreen,widebrimmedhat,bugspray,etc.)
Suppliesforyourvehicleinclude:
• Flashlight,extrabatteriesandmaps
• Firstaidkitandmanual
• Whitedistressflag
• Tirerepairkit,booster/jumpercables,pumpandflares
• Bottledwaterandnon-perishablefoodssuchasgranolabars
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Medical items/needsTheitemslistedheremayapplytomanydifferentchronicdiseases.Additionalinformationcanbefoundinthemedicalitems/needssectionsandwillhelpyouwithyourspecificneeds.
• WearamedicalIDbracelettoquicklyalertresponderstoyourconditionandallergies.
• Two-weeksupplyofallmedicationsandmedicalsuppliesandcopiesofallprescriptions incasemedicationsarelostordamaged
• Necessarymedicalequipment(e.g.oxygen,wheelchair,walker,monitors)
• Alistofimportanthealth--relatedinformation,toinclude:
ºCopyofhealthinsurancecard(s)
ºModel/serialnumberofanymedicaldevicesandcompanycontactinformation incasetheyarelostordamaged
ºSummaryofyourmedicalhistory(SeeAdditionalResources: PersonalMedicalInformationFormforasampleform)
•Listofpastandcurrentconditionsordiagnoses
•Listcurrentmedications,amountstaken,purposetaken,timestaken andanyotherspecialinformation(e.g.,takewithmeals)
•Listallergiestomedicine,foodandmaterials
•Immunizationrecord
•Namesandphonenumbersofyourhealthcareproviders
•Listofphysiciancontactinformationoutsideofareaincaseofevacuation
•Placecopiesofmedicalhistorywithyourotherimportantdocuments.
Dietary needs • Whengatheringfooditemsforyourdisastersupplieskit,keepinmindany dietaryrestrictionsyoumayhave(e.g.,lowsodium)foodsthatmaybedifficult toeatandfoodsthatyoudonottoleratewell.
• Trytopackfoodsthatyouenjoyandwilleat.Thiscanmakeadisastersituation moretolerable.Asthefoodsupplynearsitsexpirationdate,youcaneatthefood withoutwastingitthenrestockwithnewitems.
• Keepgeneralhealthguidelinesinmindwhengatheringnon-perishablefoods foryourkit.Itmaybetemptingorconvenienttoloadupyourkitwithchips, cookiesandotherkindsof“junk”foodsincetheyareusuallynonperishable. Maintainingahealthydietcanhelpyoufeelbetterandprovideadditional strengthtocopewiththesituationandfightoffillness.
Diseasespecificdietaryinformationcanbefoundinthedietarysection.
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�. Maintain Your Plan
Quiz:Reviewyourplaneverysixmonthsandquizyourfamilyaboutwhattodoinanemergency.
Drill:Conductfireandemergencyevacuationdrillsonaregularbasiswithyourfamily.
Restock:Checkfoodsuppliesforexpirationdatesanddiscardorreplacestoredwaterandfoodeverysixmonths.Ifyouhavestoredextramedicalsupplies,makesuretheyhavenotexpiredorareunusable.
Test:Readtheindicatoronyourfireextinguisher(s)andfollowthemanufacturer’sinstructionstorecharge.Testyoursmokealarmsmonthlyandchangethebatteriesatleasttwiceayear.Replacealarmsevery10years.
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IF DISASTER STRIKESIf you are instructed to take shelter immediately, do so at once!
If you are instructed to evacuate:Shouldyouneedtoevacuate,yourfirstoptionandplanshouldalwaysbetostaywithfamilyorfriends.Theycanhaveroomforyou,yourpetsandhelpyoubemostcomfortableinastressfulsituation.Emergencypublicshelterswillbeavailableandcanprovidemealsandasafeplacetostaywhileyouarethere.However,theydonotprovidepersonalhealthcare.Ifyourequirethecareofapersonalattendantandchoosetogotoashelter,bringtheattendantwithyou.
•Listentotheradioortelevisionforthelocationofemergencyshelters. Notethosethataccommodatepeoplewithspecialneeds.
•Shutoffwater,gasandelectricityifinstructedtodoso.
•Wearappropriateclothingandsturdyshoes.
•Takeyourdisastersupplieskit.
•Lockyourhome.
•Usetravelroutesspecifiedbylocalauthoritiesanddonotuseshortcuts becausecertainareasmaybeimpassableordangerous.
•Confirmuponarrivalatanemergencyshelterthatitcanmeetyourspecialcareneeds.
•Informmembersofyoursupportnetworkandout-of-towncontactofyourlocation andstatus.
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ADDITIONAL RESOURCES
�. Sources For Emergency Preparedness InformationStateKentucky Office of Homeland Securityhttp://homelandsecurity.ky.gov/
Kentucky Division of Emergency Managementhttp://kyem.ky.gov/
Kentucky Emergency Management Associationhttp://www.kyema.org/
Kentucky Cabinet for Health and Family Services Public Health Preparednesshttp://chfs.ky.gov/dph/epi/preparedness/KentuckyDisasterResponsePlans.htm
Kentucky Outreach and Information Network (KOIN)http://www.chfs.ky.gov/dph/epi/preparedness/KOIN.htm
Kentucky Community Crisis Response Boardhttp://kccrb.ky.gov/
FederalCDC Emergency Preparednesshttp://emergency.cdc.gov/
Disaster Researchhttp://www.disaster-research.us/special_needs1.htm
FEMA Disaster Preparedness Guidehttp://www.fema.gov/areyouready/
Red Cross Disaster Preparedness http://www.redcross.org/services/disaster/0,1082,0_9_,00.html
Sources for Medical EmblemsMedicAlert Foundation http://www.medicalert.org1-800-ID-ALERT(1-800-646-4777)
Yourlocalpharmacy
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2. Community Emergency/Disaster Resource FormCompletethisformasyouarepreparingyouremergencyplan.Itcanbeaquickreferenceifyouhaveaquestionorareupdatingyourplan.
Sources for Medical Emblems
Contact person or office Location Phone/Email/Web site
Emergency Preparedness Planner/Office
Contact person or office Location Phone/Email/Web site
Red Cross
Contact person or office Location Phone/Email/Web site
Public Health Department
Contact person or office Location Phone/Email/Web site
Emergency Shelters (Includespecialneedssheltersandnoteaccordingly)
Contact person or office Location Phone/Email/Web site
Other Resources (e.g.FireandPoliceDepartments,SeniorCenter,FoodBank,UtilityCompanies,etc.)
Contact person or office Location Phone/Email/Web site
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�. Personal Medical Information FormCompletethisformandupdateitregularlysoyoualwayshaveyourmedicalinformationreadytotakewithyouinadisaster.
Name: DOB:
Address:
City: State: Zip:
Home Phone: Mobile Phone:
Emergency Contacts Physician Information
Name: Primary Care Provider
Name:Address:
Address:
Phone:
Relationship: Phone:
Name: Specialty Care Provider
Name:Address:
Specialty:
Phone: Address:
Relationship:
Next of Kin: Phone:
Power of Attorney: Specialty Care Provider
Name:
Current Diagnoses
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Specialty:
Address:
2.
�. Phone:
�. Specialty Care Provider
Name:�.
�. Specialty:
�. Address:
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�. Phone:
�0.Allergies (List food, environmentaland medication allergies):Pharmacy Information
Name:
Phone:
Name:
Phone:
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Medication Information: It is important to not only know the name anddosage of the medication, but also why you take it and what can happen it you stop.
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Please copy this sheet if more medications need to be listed.
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�. Emergency Contact Information CardsMakesureyourfamilyhasaplanincaseofanemergency.Filloutthesecardsandgiveonetoeachmemberofyourfamilytomakesuretheyknowwhotocallandwheretomeetincaseofanemergency.
Emergency Contact Information Emergency Contact Information
Contact Name: Contact Name:
Phone: Phone:
Out-of-Town Contact Name: Out-of-Town Contact Name:
Phone: Phone:
Neighborhood Meeting Place: Neighborhood Meeting Place:
Phone: Phone:
Additional Important Contacts & Info Additional Important Contacts & Info
Emergency Contact Information Emergency Contact Information
Contact Name: Contact Name:
Phone: Phone:
Out-of-Town Contact Name: Out-of-Town Contact Name:
Phone: Phone:
Neighborhood Meeting Place: Neighborhood Meeting Place:
Phone: Phone:
Additional Important Contacts & Info Additional Important Contacts & Info
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�. Pets and DisastersIfyouareevacuating,remember,ifitisnotsafeforyou,itisnotsafeforyourpets.Whilepreparingyourfamily’sdisastersupplieskit,includeitemsyourpetsmayneed.ListedbelowarerecommendationsfromtheAmericanSocietyforthePreventionofCrueltytoAnimals(ASPCA):
•Food:Keepatleastathree-daysupplyoffoodinanairtight,waterproofcontainer.
•Water:Storeatleastathree-daysupplyofwaterspecificallyforyourpets inadditiontowateryouneedforyourselfandyourfamily.
•Medicines and medical records:Keepanextrasupplyofmedicines yourpettakesonaregularbasisinawaterproofcontainer.
•First aid kit:Talktoyourveterinarianaboutwhatismostappropriate foryourpet’semergencymedicalneeds.Mostkitsshouldinclude:
ºCottonbandagerolls ºLatexgloves ºBandagetape ºIsopropylalcohol ºScissors ºSalinesolution ºAntibioticointment ºPetfirstaidreferencebook ºFleaandtickprevention
•Collar with ID tag, harness or leash:
ºYourpetshouldwearacollarwithitsrabiestagandidentificationatalltimes.
ºIncludeabackupleash,collarandIDtaginyourpet’semergencysupplykit.
ºPlacecopiesofyourpet’sregistrationinformation,adoptionpapers,vaccination documentsandmedicalrecordsinacleanplasticbagorwaterproofcontainer andaddthemtoyourkit.
ºConsidertalkingwithyourveterinarianaboutpermanentidentification suchasmicrochippingandenrollingyourpetinarecoverydatabase.
•Crate or other pet carrier:
ºThecarriershouldbelargeenoughforyourpettostand,turnaroundandliedownin.
•Sanitation:
ºPetlitterandlitterbox,ifappropriate;newspapers,papertowels andplastictrashbags
ºHouseholdchlorinebleach(canbeusedasadisinfectant,dilutenine partswatertoonepartbleach)
•A picture of you and your pet together:
ºApictureofyouandyourpettogetherwillhelpyoudocumentownershipand allowotherstoassistyouinidentifyingyourpet,ifyoubecomeseparated
ºIncludedetailedinformationaboutspecies,breed,age,sex,colorand distinguishingcharacteristics
•Familiar items:
ºPutfavoritetoys,treatsorbeddinginyourkit.Familiaritemscanhelp reducestressforyourpet.
• Sheltering pets:
ºOtherthanserviceanimals,animalsarenotallowedinpublicshelters.Prepare alistoffamily,friends,boardingfacilities,veterinariansand“pet-friendly” hotelsthatcouldshelteryourpetsinanemergency.
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•Emergency contact information:
ºGathercontactinformationforemergencyanimaltreatment.
ºMakealistofcontactinformationandaddressesofareaanimalcontrolagencies includingtheHumaneSocietyorASPCAandemergencyveterinaryhospitals.
ºKeeponecopyofthesephonenumberswithyouandoneinyourpet’s emergencysupplykit.
�. Transfer TraumaDefinition:Transfertraumaisdefinedasthenegativeimpactofsuddenrelocationusuallyfollowingabrupt,unplannedmovesofthefrailelderly.Thisconditionmayoccurwhetherinashelter,hotelorstayingwithfriendsorrelatives.
Signs and Symptoms:
•Confusion
•Aggression
•ObsessiveBehaviors
•Depression
•Seriousillnessthatcouldleadtodeath
Behavioral Symptoms:
•Asksfrequently,‘Whattimeisit?”
•Distrustful-afraidsomeonewillstealtheirbelongings
•Crying
•Refusaltoeat,batheorchangeclothes
•Jumblingfacts
•Maybecomecombative
•Increasedincontinence
How to Minimize the Effects of Transfer Trauma:
•Learnallyoucanaboutthenatureofthedisaster.
•Developandupdateyourdisasterplan.
•Designatewhowillberesponsiblefortransportation ofallfamilymembers.
•Haveafamilymeetingandsharetheplanwitheveryone.
•Includephysical,personalandemotionalsecurityissuesintheplan.
•Bringacalendartoprovideavisualpictureofdayandlengthofstay.
•Establishachainofcommandandacommonmeetingplace.
•Makearrangementsforpets.
•Gathermedicalsupplies.
•Takesmallvaluablesandfamiliarobjects.
•Assignaconstantcompaniontotheelderly.
•Writedownwhereandwithwhomeachpersonisgoingandhave onepersontocontact.
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�. Stress ReactionsItisnormaltofeelanxiousandupsetwhenyouareinvolvedinadisasterorcrisissituation.Individualswithachronicdiseasemayfeelthesymptomsmoreintenselythanotherindividualswhodonothavetoplanformedicalcare.Thefollowingsignsandsymptomsareverycommonincrisissituations.Youmayexperiencejustoneorseveralatatime.Donotbetooalarmed;thesesymptomsarenormal.If,however,theylastlongerthantwotofourweeksandareaffectingyourhealth,pleasetalktoamemberofyourhealthcareteam(doctor,nurse,socialworker,etc.).
Common Symptoms of Stress •Anxiety •Sleeplessness
•CryingSpells •PanicAttacks
•Irritability •AppetiteLoss
•MemoryProblems •DifficultyMakingDecisions
•Nightmares •InabilitytoConcentrate
•Anger •FeelingOverwhelmed
Remember,inmostcases,youarereactingnormallytoanabnormalsituation.Somethingsyoucandoforyourselfandyourfamily,duringthistime,include:
•Recognizeyourownfeelings
•Talktoothers;itwillhelprelieveyourstress
•Accepthelpfromothers
•Getenoughrest
•Getasmuchphysicalactivityaspossible
�. Medical Items/NeedsMedical items/needsItisimportantthatyoutakeallmedicationsasprescribedanddonotinterruptorstopanytreatmentswithoutyourdoctor’sapproval.Doingsomayresultinareturnofyoursymptomsandprogressionofyourdisease.Adisasteroremergencysituationmaymakeitdifficulttocontinuewithyourtreatmentregime.Thatiswhyitissoimportanttoplanahead.Inadditiontothoseitemspreviouslylistedinthismanual,thefollowingmaybehelpfultohaveavailableinadisastersituation: •Ifyouusesupplementaloxygen:
ºHaveanextraportablecylinderofoxygenavailable.
ºTrytoestimatethetimeittakestouseanoxygencylinder.Thiswillhelpin determininghowlongyoursupplywilllast.Remember,stressfulsituationsmay causeyoutobreathemorequickly,causingyouroxygensupplytorundownfaster.
ºContactyouroxygenproviderandaskhowmuchoxygenisrequiredinyour homesothatoxygenflowisuninterrupted,evenduringapoweroutageorsnow emergency.Thislengthoftimeisdependentonanumberoffactors,including howeasyitistogettoyourhomewithsnoworiceontheground.
ºIfyouliveinaruralorremoteareawherefrequentorlong-lastingpoweroutages occur,youshouldconsiderpurchasingandinstallingagenerator.
ºHaveaplantoobtainadditionaloxygenshouldyoursupplyrunout.
ºPackextranasalcannulassotheycanbechangedparticularlyiftheprongs becomesoiledoruncomfortable.Inmanyplacestheyarefreefromyoursuppliers.
•Storeallofyoursuppliesandpartsforyournebulizerorothermedicalequipment inaplasticcontainerorstoragebagnexttoyourequipment.Itcanbegatheredup quicklyincaseyouhavetoevacuateyourhome.
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•Packanyitemsneededtoproperlycleanandsanitizeyourequipment.
•Includeamaskorotherequipmenttominimizeyourcontactwithirritants. Disasterscanstirupavarietyofirritants(smoke,pollen,mold,fumes,etc.).
•Youmaybeextrasensitivetotemperatureextremes(coldorhotweather). Packthefollowingitemsinyourkittohelpwiththis:
ºColdweather—acoat,sweaters,shawlsorblankets,socks,glovesanda scarforcold-weathermask(Makesurethecoatiswarm,butlight-weight enoughthatitwon’tmakeyouoverheat.)
•Coldweathercanmakearthritisandcertaincirculationproblemsworse. Packdisposableheatpackstowarmupstiffhands.
ºHot/humidweather:Asmallbattery-operatedormanualfanmayhelptokeepyoucool.
•Putonshoesandtakecomfortableslipperswithyou.
•Ifyouareonspecialtreatmentssuchaschemotherapyorradiationyoushould havecopiesofyourchemotherapyorradiationtreatmentplansinadditionto anymedicationsyouaretaking.
•Ifyouhavetoleaveyourareaandareundergoingchemotherapyorradiationtreatment, consultyourphysicianoraskyourtreatmentfacilityhowtoplanforanalternative treatmentlocationifneeded.Contactthealternativetreatmentfacilitytofindoutwhere theyarelocatedandhowitwouldworkifyouneededtoseethemduringadisaster.
•Yourconditionand/ortreatmentmaymakeyoumoresusceptibletoaninfection. Packplentyofhandsanitizer,disinfectantwipes,etc.Also,makesureyouonlydrink waterandeatfoodthatyouknowissafe.
•Somecancertreatmentsandcertainbloodpressuremedicationsandfluidpillscan makeyouverysensitivetothesun.Besuretopacksunscreen,awide-brimmedhat, anumbrellaorotheritemsthatcanshieldyoufromthesunifneeded.
•Yourconditionandtreatmentcancauseyoutobecomeeasilyfatigued.Takeseveral napsorrestbreaksduringtheday,ratherthanonelongrest.Planyourdaytoinclude restbreaks.Takeshortwalksorgetregularexercise,ifpossible.Somepeoplefindthis helpstolessentheirfatigueandraisetheirspirits.
•Sideeffectsfromcertaintreatments(e.g.,vomiting,diarrhea)mayrequireadditional medicationincludingover-the-countermedications.Remembertoconsultyour physicianaboutwhatyoucantakeandincludetheseinyourkit.
•Yourconditionmayalsorequiremorewaterthanthegallonadayperperson recommendation.Ifyouhavebeenadvisedtodrinkmorefluids,havemoreavailable.
•CommunicationDevices
ºIfyoudorequireacommunicationdevice,itmaybehelpfultohave preprogrammedstatementsorpreprintedcardsalertingrescuepersonnel ofyourconditionandpossibleneeds.
ºIfyoudonotrequireacommunicationdevice,preprintedcardslistingyour conditionandpossibleneedsmaystillbehelpful.Youmaybeunabletospeak quicklyandemergencysituationsmaymakeitdifficultforyoutoclearly communicatewithresponders.
•Storeneededmobilityaids(canes,crutches,legbraces,walkers,wheelchairs)closetoyou inaconvenientlocation.Ifpossible,keepextrasinseverallocationsthroughoutyourhouse.
•Ifyoufalleasily,considergettinghipprotectors.Inadisastersituation,youmay beforcedtogetarounddebrisorwalkaroundinanunfamiliarplace.Hipprotectors canhelppreventafractureifyoushouldfall.
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•Avoidheavyliftingorcarrying.Placedisastersuppliesinacartwithwheelsthat canbepushedorpulled.
•Aportablescalemaybenecessaryifyouhavebeentoldtomonitordailyweights forheartfailure.
•Ifyouuseawheelchair:
ºKeepapatchkitorextrainnertubesinyourkit.
ºManualwheelchair:Keepapairofheavyglovesincaseyouhavetowheelover glassorothersharpdebris.
ºMotorizedwheelchair:Incaseofapoweroutage,keepanextrabatteryandhave aplantorechargeyourchair.Forexample,purchaseaconverterthatplugsinto yourvehicle’scigarettelighter.
ºConsiderhavingalightweightmanualwheelchairasaback-up
ºTherewillbetimeswhenyoumayhavetoleaveyourwheelchairinorderto evacuatesafely.Ifyoucannotusestairs,familiarizeyourselfandyourpersonal carenetworkwithliftingandcarryingtechniquesthatworkforyou.Also,be preparedtogivetheseinstructionstorescueworkers.
ºWhenpreparingyourexitplan,makesuremorethanoneexitiswheelchairaccessible.
•Haveyourmedicationanddosingscheduleprintedoutclearly.
•Ifpossible,informanyrespondersornewcaregiversaboutanypatternofups anddownsthatarepartofyourusualfunctioningdueto“on-off”fluctuations.
�. DietaryDietary needs •Whengatheringfooditemsforyourdisastersupplieskit,keepinmindthe nonperishablefoodsinyourdisastersupplieskitshouldbeaswell-balanced aspossiblewithfoodsprovidingprotein,carbohydrates,andfats;remembering topackfoodsthatarefoundinanoverallhealthydiet.
•Keepinmindanydietaryrestrictionsyoumayhave.Forexample,foodshigh insodiumcancausefluidretentionwhichmaymakeyourfeetswellandaffectyour breathing.Mostcannedfoodscontainalotofsodium.Curedorsmokedmeats(jerky orbeefsticks)alsocontainveryhighlevelsofsalt.Ifyouareonasodiumrestricteddiet, lookfornonperishablefoodsthatarelowinsodium.
•Packnonperishablefoodsthatyouareabletoprepareandeat.Forexample,your conditionmaymakeitdifficulttouseamanualcanopener,sochoosefooditems suchasgranolabarsorcanswithpop-tops.
•Makesurethefoodsyouchoosedonotinteractorinterferewiththeeffectiveness ofyourmedications
•Ifyouuseanyspecialdevicestohelpyouprepareoreatfood,remembertoinclude theminyouremergencysupplieskit.Thesecanincludeeasytogripforks,spoons, andknives,non-skidplatesandbowls,aswellascupsandmugswithlidsandstraws.
•Someofthesesuggestionsmaybedifficulttofollowduringadisastersituation. Perishablefoodssuchasmilk,cheeseandeggsmaybehardtocomebyandare unlikelytobestoredinadisastersupplieskit.Highproteinfoodscanbefoundin nonperishableforms.Forexample,powderedmilk,cannedmeatsandproteinbars canallbeused.Otherexamplesaregranola,proteinorothermealreplacementbars thathavetearopenpackages.
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•Checktomakesurefooditemsdonotcontainanyallergensthatcanaffectyourbreathing.
•Eatingseveralsmallmealsthroughoutthedaymakesdigestioneasieronthe bodyanduseslessenergy!
•Avoidorlimitfoodsthatcauseheartburnorgas,becausebloatingmakesbreathing moredifficult.
•Maintaingoodfluidintake.Drinkplentyoffluids(atleastonegallonofwatereach day)unlessyouhavebeentoldbyyourphysiciantolimityourfluids.Thiswillprevent dehydration,especiallyifyouhavediabetesorareoncertainmedications.Italsohelps thinsecretions,makingiteasiertocoughupmucusifyouhavelungdisease.
•Ifyouhavecancer,yourdoctorordieticianmaymakerecommendationsthat aredifferentfromyourregulardiet.Youmaybetoldtoeatmorecalories.You mayalsobetoldtoincreaseyourproteinbyeatingmoreeggs,cheeseandmilk. Youmayevenbetoldtoeatlessofcertainhigh-fiberfoodsbecausetheycan aggravateproblemssuchasdiarrheaorasoremouth.
•Sideeffectsfromcancertreatmentoftenaffecteating.Itisimportanttoknowwhat theeffectsaresothatyoucanstocktheappropriatefoodsinyourdisastersupplies kit.Also,sideeffectssuchasvomitinganddiarrheamaycausedehydration.Pack extrawaterandanyover-the-countermedicationsyourdoctorhassuggestedtotreat thesesymptomsinyourkit.Workwithyourphysicianoryourdietitiantolearnabout thefoodsitemsyoushouldincludeinyourdisastersupplieskit.Yournutritionneeds andthefoodsyoutoleratewellmaychangeasyougothroughtreatment.
•Yourphysicianordietitianmayalsorecommendthatyoutakenutritionalsupplements (vitaminsand/orliquidsupplements)basedonyourindividualneeds.Rememberto includetheseinyourdisastersupplieskit.
•Iftakinginenoughcaloriesandswallowinghasbecomedifficult,youmayneedto packliquidnutritiondrinks,athickenerforfluidsorevenfeedingtubesupplements.
•Ifyouareadiabetic,besuretopickfruitcannedinjuice,notsyrup.
•Pleaseconsultyourphysicianformoreinformationoranyquestionsaboutplanning foradisasteranddietaryrestrictions.
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DISEASE SPECIFIC INFORMATION
�. Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Other Lung Diseases
AsthmaAsthmaisalungdiseasethatcausesyoutohavedifficultybreathing.Morethan20millionAmericanssufferfromasthma.Peoplewithasthmamayhaveairwaysthatareinflamed.Thismeansthattheyswellandproducelargeamountsofthickmucus.Theyarealsooverlysensitivetocertainthingslikedust,cigarettesmokeorevenexercise,whicharecalledtriggers.Thissensitivitycausesthemusclesthatsurroundtheairwaystotightenup.Thecombinationofairwayinflammationandmuscletighteningnarrowstheairwaysandmakesitdifficultforairtomovethrough.Thisiswhathappenstoaperson’slungsduringanasthmaattack.
What are the Symptoms of Asthma?
Mostpeoplewithasthmaonlyhavedifficultybreathingeverysooften.Whenitdoeshappen,itisknownasanasthmaflare-uporanasthmaattack.Apersonhavinganasthmaattackmaycough,wheeze(makeawhistlingsoundwhilebreathing),beshortofbreathandfeelanintensetightnessinthechest.Manypeoplesayitfeelsextremelyhardtogetairinandoutoftheirlungs,liketheyarebreathingthroughasmallstraw.Anasthmaattackcanlastforseveralhoursorlongerifapersondoesn’tuseasthmamedication.Afterwards,thepersonusuallyfeelsbetter.
What Causes Asthma?
Theexactcauseofasthmaisnotknown,butitisbelievedtobeacombinationofenvironmentalandgeneticfactors.Itisn’tcontagious.Asthmasymptomscanbetriggeredbymanythings.Whatcausessymptomsinonepersonmightnotbotheranotheratall.Thefollowingaresomeofthecommontriggers:
•Allergens
•Airborneirritantsandpollutants
•Exercise
•Weather
•Respiratorytractinfections
Thereareotherthingsthatcantriggersymptoms,evenlaughing,crying,andyellingcansometimescausetheairwaystotighteninsensitivelungs,triggeringanasthmaattack.
How do Doctors Diagnose Asthma?
Indiagnosingasthma,thedoctorwillstudyyourmedicalhistoryandalsoperformaphysicalexam.Yourdoctormayperformsometestsincludingspirometryandpeakflowmetertests.Thesetestsmeasurehowwellyourlungsareperforming.Yourdoctormayalsorecommendallergyteststoseeifallergiesarecausingyoursymptomsorspecialexerciseteststoseewhetheryourasthmasymptomsmaybebroughtonbyphysicalactivity.
How is Asthma Treated?
There’snocureforasthma,buttheconditioncanusuallybemanagedandflare-upscanbeprevented.Asthmaistreatedintwoways:byavoidingpotentialtriggersandwithmedication.Avoidingtriggersthatmakeasthmasymptomsworseisimportant.Theycan’talwaysbeavoided(likecatchingacold),butyoucancontrolyourexposuretosometriggers,suchaspetdander,forexample.
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Eachpersonwithasthmaistreateddifferentlybecauseeachpersonhasadifferentseveritylevelandadifferentsetoftriggers.Thereareavarietyoftreatmentmedicationsdoctorscanchoosefrom.Mostasthmamedicationsareinhaled(whichmeansthatapersontakesthemedicationbybreathingitintothelungs),butasthmamedicationscanalsotaketheformofpillsorliquids.Theyfallintotwocategories:
•Rescue medications-aretakenasneededandactquicklytohaltasthma symptomsoncetheystart.
•Controller medications-preventsymptomsfromoccurringinthefirstplace.
Manypeoplewithasthmaneedtotakemedicationeverydaytocontroltheconditionoverall.Controllermedications(alsocalled“preventive”or“maintenance”medications)workdifferentlyfromrescuemedications.Theytreattheproblemofairwayinflammationinsteadofthesymptoms(coughing,wheezing,etc.)thatitcauses.Controllermedicationsareslowactingandcantakedaysorevenweekstobeginworking.Althoughyoumaynotnoticethemworkinginthesamewayasrescuemedications,regularuseofcontrollermedicationsshouldlessenyourneedfortherescuemedications.Doctorsalsoprescribecontrollermedicationsasawaytominimizeanypermanentlungchangesthatmaybeassociatedwithhavingasthma.
Thebestwaytocontrolasthmaisprevention.Althoughmedicationscanplayanessentialroleinpreventingflare-ups,environmentalcontrolisalsoveryimportant.Herearesomethingsyoucandotohelppreventcomingintocontactwiththeallergensorirritantsthatcauseyourasthmaflare-ups:
•Keepyourenvironmentclearofpotentialallergens.
•Payattentiontotheweatherandtakeprecautionswhenyouknowweather orairpollutionconditionsmayaffectyou.Youmayneedtostayindoorsor limityourexercisetoindooractivities.
•Don’tsmoke(orifyou’reasmoker,quit).Smokingisabadhabit,especially forsomeonewhohasasthma.
•Exercise,butbecareful.Ifyou’repronetoexercise-inducedasthmaattacks, talktoyourdoctorabouthowtomanageyoursymptoms.
Preventingasthmasymptomsmaybedifficulttododuringanemergencysituation.Adisastercanstirupavarietyofirritantsintotheair.Takeprecautionsbyattemptingtoavoidareas(outdoorsorindoors)wheretherearehighlevelsofirritants.Wearingadustmaskmayalsohelptocutdownonexposure.Itisalsoimportantthatprescribedmedicationsbecontinued.Interruptingorstoppingmedicationscancauseanincreaseinairwayinflammation,leadingtocoughing,wheezing,shortnessofbreath,chesttightnessandmorefrequentasthmaattacks.Overuseoffastactingorreliefmedicationscanalsocausethemtolosetheireffectiveness.
Chronic Obstructive Pulmonary Disease (COPD)Chronicobstructivepulmonarydisease(COPD)isanumbrellatermforchronicbronchitis,emphysemaandarangeofotherlungdisorders.Thesedisordersarecharacterizedbyobstructionofairflowthatinterfereswithnormalbreathing.InCOPD,theairwaysthatcarryairinandoutofyourlungsbecomepartiallyblocked,makingitdifficulttogetairinandout.COPDisamajorcauseofdeathandillnessthroughouttheworldandisthefourthleadingcauseofdeathintheU.S.
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What are the Symptoms of COPD?
ThesymptomsofCOPDincludeacoughthatdoesnotgoaway,coughingupsputum(mucus),shortnessofbreath(especiallywithexercise),wheezingorawhistlingsoundwhenyoubreathe,tightnessinthechestandfatigue(tiredness).Thesesymptomsoftenstartyearsbeforetheflowofairinandoutofthelungsisreduced.NoteveryonewhohasacoughandsputumwilldevelopCOPDlaterinlife.
What Causes COPD?
COPDusuallydevelopsslowlyovertime.Symptomsmaydevelopwhenanindividualisbreathinginfumes,dustsandotherirritantsthatdamagethelungsandairwaysoveralongperiodoftime.Smokingtobacco(cigarettes,cigarsandpipes)isthemostcommoncauseofCOPD.MostpeoplewithCOPDaresmokersorhavebeensmokersinthepast.
Individualswhohaveworkedmanyyearsaroundcertainkindsofchemicalsandbreathedinthefumes,workedinadustyareaorhavehadheavyexposuretoairpollutionmayalsodevelopCOPD.Inrarecases,COPDiscausedbyagene-relateddisordercalledalpha1antitrypsindeficiency.Peoplewiththealpha1antitrypsinproteinintheirbloodmayexperiencelungdamageandCOPD.Ifpeoplewiththisconditionsmoke,thediseaseprogressesmorerapidly.Ifyousmoke,themostimportantthingyoucandotopreventmorelungdamageistostopsmoking.Itisalsoimportanttostayawayfrompeoplewhosmokeandplaceswhereyouknowtherewillbesmokers.
How do Doctors Diagnose COPD?
YourdoctorwilldiagnoseCOPDbyexaminingyou,listeningtoyourlungs,askingyouquestionsaboutyourmedicalhistoryandwhatlungirritantsyoumayhavebeenaroundforlongperiodsoftime.Yourdoctormayalsouseaspirometermeasurehowmuchairyourlungscanholdandhowfastyoucanblowairoutofyourlungs.Basedonthistest,yourdoctorcandetermineifyouhaveCOPDandhowsevereitis.YourdoctormayalsoorderachestX-rayandanarterialbloodgastest.Thebloodtestshowstheoxygenlevelinthebloodtoseeifoxygentreatmentisneeded.
How is COPD Treated?
ThereisnocureforCOPD.Damagetoyourairwaysandlungscannotbereversed,buttherearethingsyoucandotofeelbetter.COPDsymptomscanbemanagedanddamagetothelungscanbeslowed.Themostimportantthingyoucandotoslowtheprogressofthediseaseistoquitsmoking.Yourdoctormayrecommendtreatmentstorelieveyoursymptomsandtherearethingsyoucandotolivebetterwiththedisease.ThegoalsofCOPDtreatmentareto:
•relievesymptomswithnoorminimalsideeffectsoftreatment
•slowtheprogressofthedisease
•improvetheabilitytostayactiveandexercise
•preventanycomplicationsfromthedisease
•improvehealthoverall
Treatmentforeachpersonisdifferentandisbasedonwhethersymptomsaremild,moderateorsevere.Thereareavarietyoftreatmentsthatcanhelpreducesymptomsandmanagecomplications,including:
•Bronchodilators-medicationsthatworkbyrelaxingthemusclesaroundyourairways, openingthemandmakingiteasiertobreathe.Theycanlasteither4-6hoursor12hours, dependingonthetype.Mostareinhaleddirectlyintothelungswiththeuseofaninhaler.
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• Inhaled steroids-usedforsomepeoplewithmoderateorsevereCOPD toreducetheinflammationorswellingintheairways.
•Vaccines-itisrecommendedthatyougetapneumococcalvaccinetoprevent pneumoniaandanannualflushottoavoidanybreathingcomplications.
•Pulmonary or lung rehabilitation (rehab)-helpsyoustayactivedespiteyour COPD.Itincludesexercisetraining,nutritionadviceandeducationaboutmanaging thedisease.Acustompulmonaryrehabprogramismanagedbyamultidisciplinary team(doctors,nurses,respiratorytherapists,exercisespecialists,dietitians).
•Oxygen therapy-forsevereCOPDandlowlevelsofoxygenintheblood.Usingextra oxygencanhelpyouperformtasksoractivitieswithlessshortnessofbreath,protect theheartandotherorgansfromdamage,improvethequalityanddurationofyoursleep, improveyouralertnessduringthedayandhelpyoulivelonger.
•Surgery-isusuallydoneforpatientswhohaveseveresymptoms,havenotimproved withmedicationsandhaveahardtimebreathingmostofthetime.Therearetwotypes ofsurgeryforCOPD:abullectomy,whichremovesalargeairsacthatmaycompressa goodlung,oralungtransplant.
ThegoalofCOPDtreatmentistopreventorminimizetheprogressionofthedisease.Duringadisasteroremergencysituationitmaybedifficulttofollowalltreatmentrecommendations.Stoppingtreatmentsmayincreasethefrequencyorseverityofbreathingdifficulties.Youmayalsobecomeoverlytiredandeventuallyrequirehospitalization.Youshouldalsocallyourdoctorifyouhavesuddenchesttightness,morecoughing,achangeinyoursputumorfever.Thiscouldsignalalunginfection.Itisimportantthatalltreatmentrecommendationsbefollowedtothebestofyourabilityinordertomaintainlungfunction,preventfurtherlungdamageandmaintainyourqualityoflife.
Chronic BronchitisChronicbronchitisisaninflammationofthemainairwaysinthelungsthatcontinuesforalongperiodoftimeorkeepscomingback.Cigarettesmokingisthemaincauseofchronicbronchitis.Themoreapersonsmokes,themorelikelythepersonwilldevelopseverebronchitis.Secondhandsmokemayalsocausechronicbronchitis.Airpollution,infectionandallergiesmakechronicbronchitisworse.
Symptomsincludeacoughthatproducesmucus(sputum),whichmaybebloodstreaked;shortnessofbreathaggravatedbyexertionormildactivity;frequentrespiratoryinfectionsthatworsensymptoms;wheezing;fatigue;ankle,footandlegswellingthataffectsbothsides;andheadaches.
Chronicbronchitisisoneformofchronicobstructivepulmonary(lung)disease.Chronicbronchitis,emphysema,andasthmaasagrouparealeadingcauseofdeathintheU.S.
EmphysemaEmphysemaisalungdiseasethatinvolvesdamagetotheairsacs(alveoli)inthelungs.Theairsacsareunabletocompletelydeflate,andarethereforeunabletofillwithfreshairtoensureadequateoxygensupplytothebody.
Cigarettesmokingisthemostcommoncauseofemphysema.Tobaccosmokeandotherpollutantsarethoughttocausethereleaseofchemicalsfromwithinthelungsthatdamagethewallsoftheairsacs.Thisdamagebecomesworseovertime,affectingtheexchangeofoxygenandcarbondioxideinthelungs.
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Symptomsofemphysemaincludeshortnessofbreath;chroniccoughwithorwithoutsputumproduction;wheezinganddecreasedabilityabilitytoexercise.Additionalsymptomsthatmaybeassociatedwiththisdiseaseinclude:anxiety;unintentionalweightloss;ankle,feet,andlegswelling;andfatigue.
Smokingcessationisthemostimportantandeffectivetreatment.Quittingsmokingcanstoptheprogressionoflungdamageonceithasstarted.Medicationsusedtoimprovebreathingincludebronchodilators(hand-heldinhalerornebulizer),diureticsandcorticosteroids.Antibioticsmaybeprescribedwhenrespiratoryinfectionsoccur.Influenza(flu)vaccinesandPneumovax(pneumoniavaccine)arerecommendedforpeoplewithemphysema.
Sources for Additional Asthma,COPD and Other Lung Diseases Information
American Lung Associationwww.lungusa.org1-800-LUNG-USA(1-800-586-4872)
Asthma and Allergy Foundation of Americawww.aafa.org1-800-7-ASTHMA(1-800-727-8462)
National Heart Lung and Blood InstituteCOPD-http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.htmlAsthma-http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html
Kentucky Cabinet for Health and Family ServicesCOPD-http://chfs.ky.gov/dms/hi/COPD.htmAsthma-http://chfs.ky.gov/dms/hi/Asthma.htm
Free Tobacco Cessation Assistance1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov
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2. Cancer
Cancerisanumbrellatermformorethan100life-threateningdiseasescharacterizedbytheuncontrolled,abnormalgrowthofmalignant(cancerous)cells.Normally,cellsgrowanddivideuntiltheyeventuallydie.Cancercellscontinuetogrowanddivide.Theresultingmassortumorcaninvadeanddestroysurroundingnormaltissues.
What are the Symptoms of Cancer?
Therearemanydifferenttypesofcancer.Asaresult,therearemanydifferentsymptoms.Thereareafewcommonsymptomsincluding:
•Unintentionalweightloss •Swellingorlumpsincertainparts (10ormorepounds) ofthebody(e.g.,abdomenorneck)
•Extremeexhaustion •Problemswithwalkingorbalance
•Headaches •Moreinfections
•Blurredvision •Unusualbleeding
•Nausea
What Causes Cancer?
Scientistsandresearchersdonotreallyknowwhatcausescancer,butthereissomeunderstandingofwhypeoplegetcancer.Peoplegetcancerbasedontheirgeneticsandcertainenvironmentalorbehavioraltriggers.Forexample,ifacloserelativehadlungorskincancer,youmaybemorelikelytoinheritthetendencytogetlungorskincancer.Ifyouareexposedtoenvironmentalorbehavioraltriggerssuchassmokingcigarettesorexcessivesunexposure,youmaybemorelikelytogetlungorskincancer.Thecombinationofgeneticsandenvironmentalandbehavioraltriggersdeterminethelikelihoodthatyouwillgetcancer.
How do Doctors Diagnose Cancer?
Ifcancerissuspected,yourdoctorwillorderseveraltests.Thesemayincludebloodtests,x-raysoranMRI.Abiopsy,whichinvolvestheremovalofasmalltissuesampletoexamineitforcancercells,mayalsobeperformed.
How do Doctors Treat Cancer?
Therearethreecommonmethodsfortreatingcancer:surgery,chemotherapyandradiation.Cancertreatmentplansaretailoredtoeachpatientbecausecancerisdifferentineachpatient.Apersonwithcancermayundergoanyoneofthesetreatmentsoracombinationofthem:
•Surgeryremovescanceroustissue.Asurgeonremovesthecanceroustissuealongwith asmallamountofthehealthytissuesurroundingittomakesurethatallthecancer isremovedandhasnotspread.
•Chemotherapyisthetreatmentofcancerusingmedicationtodestroymalignant (cancerous)cells.Sideeffectsincludenausea,fatigue,hairlossorothersideeffects. Chemotherapymaydestroysomehealthycellsintheprocessofremovingofthe malignantcells.Thesehealthycellswilleventuallystarttogrowagainandthe sideeffectsshoulddisappear.
•Radiation or radiotherapyiswhenhighlevelsofradiationareusedtokillcancercells ortoshrinktumors.Itisusuallypainless,buttherearesideeffectsincludingfatigue,
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nausea,vomitingordiarrhea.Sometimes,theareaofskinthathasbeenirradiated becomesinflamed.Mostofthesesideeffectsaretemporary.
Aninterruptioninchemotherapyorradiationtreatmentcanresultinaspreadofthecanceroramorerapidprogressionofthedisease.Itcanalsoincreaseanypainthattheindividualwassufferingduetothecancer.Itisimportantthatyourtreatmentscontinueasscheduledeveninadisaster.
Side Effects to Certain Cancer Treatments
Cancer Treatment How it Can Affect Eating What Sometimes Happens: Side Effects
Surgery Increases the need for good nutrition.May slow digestion. May lessen the ability of the mouth, throat and stomach to work properly. Adequate nutritionhelps wound-healing and recovery.
Before surgery, a high-protein, high-calorie diet may be prescribed if a patient is underweight or weak. After surgery, some patients may not be able to eat normally at first. They may receive nutrients through a needle in their arm or through a tube in their nose or stomach.
Radiation Therapy
As it damages cancer cells, it also may affect healthy cells and healthy parts of the body.
Treatment of head, neck,chest or breast may cause: • Dry mouth • Sore mouth • Sore throat • Difficulty swallowing (dysphagia) • Change in taste of food • Dental problems • Increased phlegm • Nausea and vomiting • Diarrhea • Cramps, bloating
Chemotherapy As it destroys cancer cells, it also may affect the digestive system and the desire or ability to eat.
• Nausea and vomiting • Loss of appetite • Diarrhea • Constipation • Sore mouth or throat • Weight gain or loss • Change in taste of food
Biological Therapy Immunotherapy
As it stimulates your immune system to fight cancer cells, it can affect the desire or ability to eat.
• Nausea and vomiting • Diarrhea • Sore mouth • Severe weight loss • Dry mouth • Change in taste of food • Muscle aches, fatigue, fever
Hormonal Therapy
Some types can increase appetite and change how the body handles fluids.
• Changes in appetite • Fluid retention
Chart source: National Cancer Institute www.cancer.gov
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Sources for Additional Cancer InformationAmerican Cancer Societyhttp://www.cancer.org1-800-ACS-2345TTY:1-866-228-4327
National Cancer Institutehttp://www.cancer.gov1-800-4-CANCER(1-800-422-6237)TTY:1-800-332-8615
Kentucky Cancer Programhttp://louisville.edu/org/kycancerprogram
Cancer Carehttp://www.cancercare.org1-800-813-HOPE(1-800-813-4673)
National Coalition for Cancer Survivorshiphttp://www.canceradvocacy.org1-888-650-9127
Free Tobacco Cessation Assistance1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov
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�. Dementia and Memory Loss
Dementiaisaconditionofdecliningmentalabilities,especiallymemory.Anindividualwithdementiawillhaveproblemsdoingthingsheorsheusedtobeabletodo,likekeepthecheckbook,driveacarsafelyorplanameal.Theindividualwilloftenhaveproblemsfindingtherightwordsandmaybecomeconfusedwhengiventoomanythingstodoatonce.Dementiamayalsocausechangeinpersonality,makingonebecomeaggressive,paranoidordepressed.
Itmaytakelongertorememberthingsortofindtherightwordtosayaspeoplegetolder,butthisisnotdementia.Dementiacausesmentalchangesthatkeeppeoplefromdoingthethingstheyusedtodo.Agingalonedoesnotinterferewiththeabilitytofunction.
What are the Symptoms of Dementia?
Dementiacausesmanyproblemsforthepersonwhohasitandfortheperson’sfamily.Manyoftheproblemsarecausedbymemoryloss.Somecommonsignsofdementiaarelistedbelow.Noteveryonewhohasdementiawillhaveallofthesesigns.
•Recent memory loss-Peoplewithdementiaoftenforgetthings,buttheynever rememberthem.Theymightaskyouthesamequestionoverandover,eachtime forgettingthatyou’vealreadygiventhemtheanswer.Theywon’tevenremember thattheyalreadyaskedthequestion.
•Difficulty performing familiar tasks-Peoplewhohavedementiamightcook amealbutforgettoserveit.Theymightevenforgetthattheycookedit.
•Problems with language-Peoplewhohavedementiamayforgetsimplewords orusethewrongwords.Thismakesithardtounderstandwhattheywant.
•Time and place disorientation-Peoplewhohavedementiamaygetlostontheirown street.Theymayforgethowtheygottoacertainplaceandhowtogetbackhome.
•Poor judgment-Peoplewhohavedementiacanforgetsimplethings,likeforgetting toputonacoatbeforegoingoutincoldweather.
•Problems with abstract thinking-Peoplewhohavedementiamayforgetwhat numbersareandwhathastobedonewiththem.
•Misplacing things-Peoplewhohavedementiamayputthingsinthewrongplaces andcan’tfindthemlater.
•Changes in mood-Peoplewithdementiamayhavefastmoodswings,goingfrom calmtotearstoangerinafewminutes.
•Personality changes-Peoplewhohavedementiamayhavedrasticchanges inpersonality.Theymightbecomeirritable,suspiciousorfearful.
•Loss of initiative-Peoplewhohavedementiamaybecomepassive.Theymight notwanttogoplacesorseeotherpeople.
What Causes Dementia?
Therearemanycausesofdementia,includingstrokes,lowvitaminB12levels,thyroidconditions,depression,AIDSandotherinfections.Medicationsandsomeillnessescancauseconfusion(delirium)inolderpeoplethatmaylooklikedementia.Dementiaisalsocausedbythedestructionofbraincells.Aheadinjury,astroke,abraintumororAlzheimer’sdiseasecandamagebraincells.
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How do Doctors Diagnose Dementia?
Ifdementiaissuspected,thedoctorwillperformamedicalexam,orderbloodworkandrunsomememorytests.Othertests,includingaCTscanorMRIscanofthebrain,mayalsobedone.
How is Dementia Treated?
Somecasesofdementiaarecausedbymedicalconditionsthatcanbetreated,fullyorpartlyrestoringmentalfunction.Whendementiacannotbereversed,thegoaloftreatmentistomakelifeaseasyaspossibleforthepersonandthecaregivers.
Ifthecauseofdementiacanbereversed,thedoctorwillprescribetreatment.Forexample,thepersonmighttakevitaminsforadeficiencyoffolicacid,vitaminB12,orthiamine;takemedicinestotreataninfection,suchasencephalitis,thatiscausingchangesinmentalstate;orstoporchangemedicationsthatarecausingmemorylossorconfusion.
Ifthecauseofdementiacannotbetreated,thedoctorwillworkwiththepersonandcaregiverstodevelopaplantomakelifeeasierandmorecomfortable.Careplansmayincludetipstohelpthepersonbeindependentandmanagedailylifeaslongaspossible.Educationofthefamilyandothercaregiversiscriticaltosuccessfullycaringforapersonwithdementia.
Tips for Managing a Person with Dementia in a DisasterPeoplewithdementiaareespeciallyvulnerabletochaosandemotionaltrauma.Theyhavealimitedabilitytounderstandwhatishappening,andtheymayforgetwhattheyhavebeentoldaboutthedisaster.Planningaheadnowcanhelptoreducetraumaandeaseagitationshouldanemergencyordisastersituationoccur.Inadditiontothoselistedpreviouslyinthismanual,otheritemsthatmaybehelpfultohaveinadisastersituation,include:
Additional Items to Include in Your Kit
•Changeofclothing—makesuretheseitemsarecomfortabletowearandareeasy togetonoroff.
•Sleepingbagorwarmblanket—olderindividualscannottoleratethecoldas wellasyoungerpeople.Considerpackingextrablankets.Also,afamiliarblanket maybeacomfortitemtoanindividualwithdementia.
•Extraidentificationitemssuchasclothingtags,walletcardsorIDjewelry (bracelets,necklace,dogtags,etc.)
•Arecentphotoofyourlovedoneincasehe/shewandersawayinthecommotion
•Activitiestokeeptheindividualoccupied(e.g.,books,crosswordpuzzles, newspapers,playingcards)
•Additionalhealthcareinformation:
ºCopiesofanylegaldocumentssuchasyourpowerofattorney
ºMakesureothercareattendantsthathelpyoualsohavecopiesofyourloved one’sdementiamedicalhistory,physicianinformationandfamilycontacts.
During an Evacuation
Bealerttopotentialreactionsthatmayresultfromchangesinroutine,travelingornewenvironments.
•Whenappropriate,informothers(hotelorshelterstaff,familymembers,airlineattendants) thatyourlovedonehasdementiaandmaynotunderstandwhatishappening.
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•Donotleavethepersonalone.Itonlytakesafewminutestowanderawayandgetlost.
•Don’taskastrangertowatchtheperson.Apersonwhodoesn’tunderstanddementia anditseffects,andwhodoesn’tknowyouortheperson,won’tunderstandhowtoreact inadifficultsituation.
•Changesinroutine,travelingandnewenvironmentscancause:
ºAgitation
ºWandering
ºIncreaseinbehavioralsymptoms,includinghallucinations,delusionsandsleepdisturbance
ºDoyourbesttoremaincalm.Thepersonwithdementiawillrespondtothe emotionaltoneyouset.
Tips for Preventing Agitation
•Trytospendextratimewiththepersontohelphimorheradjusttothenewenvironment.
•Trytomaintaindailyroutinesasmuchaspossible.
•Reassuretheperson.Holdhandsorputyourarmonhisorhershoulderandassure themthingswillbefine.
•Findoutletsforanxiousenergy.Takeawalktogetherorengagethepersoninsimpletasks.
•Redirecttheperson’sattentionifheorshebecomesupset.
•Limitnewsmediaexposuretothedisaster.
•Movethepersontoasaferorquieterplace,ifpossible.Limitstimulation.
•Makesurethepersontakesmedicationsasscheduled.
•Trytoscheduleregularmealsandmaintainaregularsleepschedule.
•Avoidelaborateordetailedexplanations.Provideinformationusingconcreteterms. Followbriefexplanationswithreassurance.
•Bepreparedtoprovideadditionalassistancewithallactivitiesofdailyliving.
•Payattentiontocuesthatthepersonmaybeoverwhelmed(fidgeting,pacing).
•Remindthepersonthatheorsheisintherightplace.
•Providecomfortitems,suchas:
ºApilloworfamiliarstuffedanimalthatcanbehugged
ºLotionorotheritemsthatcanhelpsoothetheindividual
Helpful Hints During an Episode of Agitation
•Approachthepersonfromthefrontandusehisorhername.
•Usecalm,positivestatementsandapatient,low-pitchedvoice.Reassure.
•Respondtotheemotionsbeingexpressedratherthanthecontentofthewords.For example,say,“You’refrightenedandwanttogohome.It’sokay.I’mrightherewithyou.”
•Don’targuewiththepersonortrytocorrecthim.Instead,affirmhisorherexperience, reassureandtrytodivertattention.Forexample,say,“Thenoiseinthisshelteris frightening.Let’sseeifwecanfindaquieterspot.Let’slookatyourphotobooktogether.”
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Wandering Behavior
•Identifythemostlikelytimesofdaythatwanderingmayoccur,andplan activitiesatthattime.
•Provideopportunitiesforactivitiesandexercise,suchasfoldingtowels, listeningtomusicanddancing.
•Whennightwanderingisaproblem,makesurethepersonhasrestrictedfluids twohoursbeforebedtimeandhasgonetothebathroomjustbeforebed.Limit daytimenaps,ifpossible.
•Monitorreactiontomedications.Consultaphysician,ifnecessary.
•Utilizecommunicationfocusedonexplorationandvalidation(notcorrecting) whentheindividualsaysthatheorshewanttoleavetogohomeortowork.
•Ifwanderingisinprogress,usedistractiontore-directtheindividual’sfocus.
•ConsiderenrollingyourlovedoneintheAlzheimer’sAssociation’sSafeReturn®
program[moreinformationinnextsection].Anindividualwithdementiamay nothavethisparticulardisease,butwanderingbehaviormaybeasymptomof hisorherdementia.Thisprogramcanhelpinlocatinganindividual.
Take Care of Yourself
•Takecareofyourselfbyfindingagoodlistenertohearyourthoughts andfeelingsabouttheevent.
•Findmomentstobreathe,meditateandreflect.
•Ensurepropernutritionandhydration.
Alzheimer’s Association Safe Return®
TheAlzheimer’sAssociationSafeReturn®programassistsinthesafereturnofindividualswithAlzheimer’sdiseaseorarelateddementiawhowanderandbecomelost.SafeReturnisanationwideidentificationandsupportprogramworkingatthecommunitylevel.Assistanceisavailable24hoursadaywheneverapersonislostorfound.OnecallimmediatelyactivatesthecommunitysupportnetworktohelpreunitealostpersonwithAlzheimer’sdiseasewithhisorhercaregivers.Whenanindividualismissing,SafeReturnfaxestheenrolledperson’sinformationandphototolocallawenforcement.Whenapersonisfound,acitizenorlawofficialcallsthe800-numberandSafeReturnnotifieslistedcontacts.ThelocalAlzheimer’sAssociationchapterprovidessupporttothefamilyduringtheincident.
Safe Return® Benefits
•TheAlzheimer’sAssociation24-hourtoll-freeemergencyincidentline
•AregistrationlineavailableMondaythroughFridaybetween7a.m.and11:30p.m.(CST)
•Personalizedidentificationproducts
•FivestepsforaSafeReturn®magnetcard,whichprovidesusefultipswhensomeoneismissing
•Enrollmentinanationalinformationandphotodatabasethatincludesemergency contactinformationtohelpreunitealostpersonwithhisorhercaregivers
•TheAlzheimer’sAssociation24/7Helpline,whichisavailabledayandnight, everyday,forinformationandcareconsultation
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•YourAlzheimer’sAssociationlocalchapter,whichprovidesinformation, referralandotherservices
•Educationandtrainingonwanderingbehaviorforfamilies,caregivers andemergencyresponders
Forsafetyandpeaceofmind,enrollinSafeReturntoday.Contactustodaybycallingtoll-freeat1.888.572.8566oronlineathttp://www.alz.org/safereturn.
TheAlzheimer’sAssociation,theworldleaderinAlzheimerresearch,careandsupport,isdedicatedtofindingpreventionmethods,treatmentsandaneventualcureforAlzheimer’s.
24/7Helpline800-272-3900TDDAccess312-335-8882Websitehttp://[email protected]
©2006Alzheimer’sAssociation.Allrightsreserved.©10/27/97PF/226/RAlzheimer’sAssociationSafeReturn®ThisisanofficialpublicationoftheAlzheimer’sAssociationbutmaybedistributedbyunaffiliatedorganizationsandindividuals.SuchdistributiondoesnotconstituteanendorsementofthesepartiesortheiractivitiesbytheAlzheimer’sAssociation.
Sources for Additional Dementia and Memory Loss Information
National Institute for Neurological Disorders and Strokehttp://www.ninds.nih.gov/disorders/dementias/dementia.htm
Alzheimer’s Association http://www.alz.orgTel:1.800.272.3900
Alzheimer’s Association Safe Returnhttp://www.alz.org/safereturnTel:888.572.8566
National Institute on Aging Alzheimer’s Disease Education and Referral (ADEAR)http://www.alzheimers.nia.nih.govTel:1.800.438.4380
Family Caregiver Alliance http://www.caregiver.orgTel:1.800.445.8106
Children of Aging Parentshttp://www.caps4caregivers.orgTel:800.227.7294
Eldercare Locatorhttp://www.eldercare.govTel:800.677.1116
Well Spouse Associationhttp://www.wellspouse.orgTel:800.838.0879
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�. Diabetes
Ifyouhavediabetes,yourbodycannotmakeorproperlyuseinsulin.Insulinisahormonethathelpscontrolthesugar,orglucose,inyourblood.Glucoseisthemainsourceoffuelforyourbody.Whenyouhavediabetes,thelevelsofbloodglucosearetoohigh.Thereare20.8millionchildrenandadultsintheU.S.,or7percentofthepopulation,whohavediabetes.Whileanestimated14.6millionhavebeendiagnosed,6.2millionpeople(ornearlyone-third)areunawarethattheyhavethedisease.
What are the Symptoms of Diabetes?
Diabetesisoftencalleda“silent”diseasebecausemanypeoplehavenosignsorsymptomsbeforetheyarediagnosed.Symptomscanalsobesomildthatyoumightnotnoticethem.Morethan5millionpeopleintheU.S.havetype2diabetesanddonotknowit.Thesignsofdiabetesare:
•Beingverythirsty •Havingsoresthathealslowly •Urinatingoften •Havingdry,itchyskin •Feelingveryhungryortired •Havingblurryeyesight •Losingweightwithouttrying •Losingthefeelinginyourfeetorhaving tinglinginyourfeet
What Causes Diabetes?
Diabetespreventsthebodyfromproperlyconvertingfoodsintotheenergyneededfordailyactivity.Whenyoueat,yourbodychangesmostofthefoodintoaformofsugarcalledglucose.Glucosetravelsthroughthebloodstreamto“fuel,”yourcells.Forglucosetogetintocells,thehormoneinsulinmustbepresent.Ifyourbodydoesnotmakeenoughinsulinoriftheinsulindoesn’tworkthewayitshould,glucosecan’tgetintoyourcells.Itremainsinyourblood,whilethecellsarestarvedofenergy.Thelevelofglucoseinyourbloodthengetstoohigh,causingdiabetes.Overtime,highlevelsofglucoseintheblooddamagenervesandbloodvessels.Thiscanleadtocomplicationssuchasheartdiseaseandstroke,kidneydisease,blindness,nervedamage,guminfectionsandlowerlimbamputation.
•Type �diabetesisanautoimmunedisease.Theimmunesystemattacksthe insulin-producingcellsinthepancreasanddestroysthem.Thepancreasthen produceslittleornoinsulin.
•Type 2diabetes,themostcommonform,usuallybeginswhenthecellsdonotuse insulinproperly(calledinsulinresistance).Astheneedforinsulingoesup,the pancreasgraduallylosesitsabilitytoproduceasmuchasneeded.Insulinproduction tendstodecreaseinpeoplewithType2diabetesafterseveralyears.
Diabetesriskfactorsinclude:
•Beingoverweightorobese
•Havingafirst-degreerelative(aparent,brotherorsister)withdiabetes
•BeingAfricanAmerican,AmericanIndianorAlaskanNative,AsianAmerican orPacificIslanderorHispanicAmerican/Latino
•Havinggestationaldiabetes,orgivingbirthtoatleastonebabyweighingmore than9pounds
•Havingbloodpressureof140/90orhigher,orhavingbeentoldthatyouhave highbloodpressureorontherapyforhighbloodpressure
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•Havingabnormalcholesterollevels(HDLlevelof35orlower,oratriglyceridelevel of250orhigher)
•Beinginactiveorexercisingfewerthanthreetimesaweek
•WomenwithPolycysticOvarianSyndrome(PCOS)
•Conditionsassociatedwithinsulinresistance(severeobesityandacanthosisnigricans)
•Historyofcardiovasculardisease
How do Doctors Diagnose Diabetes?
Doctorsusethefollowingteststodiagnosediabetes:
•Fasting plasma glucose (FPG test)-measuresyourbloodglucoseafteryouhave goneatleast8hourswithouteating.
•Oral glucose tolerance test (OGTT)-measuresyourbloodglucoseafteryouhave goneatleast8hourswithouteatingand2hoursafteryoudrinkasweetbeverage.
•Random plasma glucose test–measuresbloodglucosewithoutregardtowhen youateyourlastmeal.
How is Diabetes Treated?
Diabetescannotbecured,butitcanbecontrolled.Strictcontrolofbloodglucose,orbloodsugar,aswellasbloodpressureandcholesterolisthebestdefenseagainsttheseriouscomplicationsofdiabetes.Peoplewithtype1diabetescontroltheirbloodsugarwithinsulininjectionsandfrequentself-monitoringofbloodglucose.Peoplewithtype2diabetesgenerallycontroltheirbloodsugarwithoralmedicationsand,insomecases,insulin.Sometimesapersonwithtype2diabetescancontrolbloodglucoselevelswithdietandexercisealone.Goodcontrolofbloodglucoserequires:
•Following a Meal Plan:Healthyeatingisveryimportant,helpingyoureachandstay atahealthyweight,keepingyourbloodglucoseinadesirablerangeandpreventing heartandbloodvesseldisease.
•Getting Regular Physical Activity:Exercisehelpskeepweightdown,helpsinsulin workbettertolowerbloodglucose,isgoodforyourheartandlungsandgivesyou moreenergy.Beforeyoubeginexercising,talkwithyourdoctor.
•Taking Your Diabetes Medicine Every Day
•Checking Your Blood Glucose as Recommended
•Monitoring Your Diabetes ABCs:Heartdiseaseandstrokearetheleadingcauses ofdeathforpeoplewithdiabetes.Ifyouhavediabetes,heartdiseaseismorelikely tostrikeyouandatanearlieragethansomeonewithoutdiabetes.Therefore,people withdiabetesneedtocontroltheirA1Corbloodglucoseaverage,theirBloodpressure, andtheirCholesterol--theABCsofdiabetes.
Propermonitoringofyourdiabetesisvital,especiallyinadisastersituation.Whileitmaybedifficulttomonitorglucoselevelsandtakemedications,failingtodothiscanleadtodiabeticcomplicationsincluding:
•Visionproblems–diabetesistheleadingcauseofblindnessintheU.S.
•Numbnessorpaininarms,legs,handsandfeet
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•Kidneydisease
•Increasedriskforheartdisease
•Poorwoundhealing
•Decreasedimmunesystemfunction
•Diabeticketoacidosis–thisisasevereandlifethreateningcomplication
Foot Care
Footcareisveryimportantforpeoplewithdiabetes.Highbloodglucoselevelsandareducedbloodsupplytothelimbscausenervedamagethatreducesfeelinginthefeet.Someonewithnervedamagemaynotfeelapebbleinsidehissockthatiscausingasore.Onemaynotfeelablistercausedbypoorlyfittingshoes.Footinjuriessuchasthesecancauseulcers,whichmayleadtoamputation.Peoplewithdiabetesshouldchecktheirfeeteverydayandwatchforanycuts,sores,redspots,swellingandinfectedtoenails.Thisisespeciallytrueinadisasterssituationwhenyouaremorelikelytobewalkingonoroverdebris.Sores,blisters,breaksintheskin,infectionsorbuildupofcallusesshouldbereportedrightawaytoapodiatristorafamilydoctor.
Skin Care
Skincareisveryimportanttoo.Becausepeoplewithdiabetesmayhavemoreinjuriesandinfections,theyshouldprotecttheirskinbykeepingitclean,usingskinsoftenerstotreatdrynessandtakingcareofminorcutsandbruises.Preventingcutsorscrapesmaybedifficultinadisastersituation.Besuretopackafirstaiditemsintoyourdisastersupplieskit.Ifawoundappearstobeinfectedornothealingproperly,seekmedicalattentionimmediately.
•Ifyouareadiabetic,makesureyouincludeyourglucosetestingsuppliesincluding yourglucosemeter,extrainsulin,glucagon,syringes,lancets,bloodteststrips,ketone teststripsandalcoholwipes.
•Insulinpumpusersshouldhavebasalrates,insulin-to-carbratiosandcorrectionfactors andanysuppliesassociatedwiththepump.
•Extrabatteriesforyourglucosemonitorand/insulinpump
•Ifanyofyourmedications(e.g.,insulinandcertainosteoporosisandarthritisinjections) requiresrefrigeration,makesureyourkitcontainsasmallinsulatedcooler.Haveiceready orpurchaseFRIOcoolingpacks.
•Inadisaster,itmaybedifficulttomonitoryourbloodsugarasoftenasyoushould. Trytodoyourbest.Payattentiontoanyunusualsymptomsyoumayexperienceand seekhelpimmediately.
•Trytopreventthefollowing:
ºDehydration–Rememberitcanbecausedbyhyperglycemia(highbloodsugar). Makesuretogetenoughfluidstomeetyourbody’sneeds.
ºHypoglycemia(lowbloodsugar)–Trytokeepsomethingwithsugaroremergency glucosetabswithyouatalltimes.
ºInfections(especiallyfootinfections)–Tryyourbesttoavoidwadingthrough contaminatedwaterorinjuringyourfeet.Inspectthemregularlyforcuts,sores orblisters.Seekmedicalcareimmediatelyifyounoticeanysignsofinfection (swelling,redness,and/ordischargefromawound).
ºHyperglycemia(highbloodsugar)–Makesureyoutakeyourmedicationsas prescribedbythedoctorandavoidfoodchoicesthatcanincreaseyourbloodsugar.
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Sources for Additional Diabetes InformationAmerican Diabetes Associationhttp://www.diabetes.org1-800-DIABETES(1-800-342-2383)
Kentucky Cabinet for Health and Family Serviceshttp://chfs.ky.gov/dph/ach/cd/diabetes.htm1-502-564-7996
Defeat Diabetes Foundation, Inc.http://www.defeatdiabetes.org
National Diabetes Information Clearing Househttp://diabetes.niddk.nih.gov1–800–860–8747
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�. Heart Disease, High Blood Pressure and Stroke
Heart Disease
Heartdiseasecanbedefinedasanyofanumberofdiseasesrelatedtotheheartandbloodvessels.Whengroupedtogether,thesediseasesaretheleadingcauseofdeathintheU.S.Today,morethan80millionAmericanshavesomeformofit.Thisdiseaseincludesavarietyofproblems,includingheartfailure,highbloodpressureandstroke.Someotherproblemsthatgoalongwithheartdiseaseare:
•Hardeningofthearteries,alsocalledarteriosclerosis,meansthearteriesbecome thickenedandarenolongerasflexible.
•Abuildupofcholesterolandfatthatmakestheirarteriesnarrowersolessblood canflowthroughiscalledatherosclerosis.Thosedepositsarecalledplaque.
•Apaininthechestthatmeanstheheartisn’tgettingenoughbloodiscalledangina.
•Whenabloodclotorotherblockagecutsbloodflowtoapartoftheheartitis calledaheart attack.
Heart Failure
Inheartfailure,theheartcannotpumpenoughbloodthroughthebodyoritcannotfillwithenoughbloodorpumpwithenoughforceorboth.Heartfailuredevelopsovertimeasthepumpingactionoftheheartgetsweaker.Itcanaffecttheright,theleft,orbothsidesoftheheart.Inmostcases,heartfailureaffectstheleftsideoftheheartwhenitcannotpumpenoughoxygen-richbloodtotherestofthebody.Whenheartfailureaffectstherightside,theheartcannotpumpenoughbloodtothelungs,whereitpicksupoxygen.
What are the Symptoms of Heart Failure?
Commonsymptomsofheartfailurearefatigue,shortnessofbreathandswelling.Thisisbecausetheheartcan’tpumpbloodinandoutoftheheartwellenoughtopreventbloodandfluidfrombackingup.Thefluidbackupcausesswellingintheankles,feet,legsandsometimesintheabdomen.Thisfluidbuildupcanleadtoweightgain,frequenturinationandachroniccough.Thecoughcanbeworseatnightandwhenlyingdown.
What Causes Heart Failure?
Heartfailureiscausedbyotherconditionsthatdamagetheheartmuscleincludingcoronaryarterydisease,heartattacksandheartdefects.Diabetesandhighbloodpressurecanalsocontributetoheartfailurerisk.
How is Heart Failure Diagnosed?
Manyofthesymptomsofheartdiseasearesimilartothoseofotherdiseases.Becauseofthis,thereisnosingletestthatcandetectheartdisease.Aphysicianwillmakeaheartfailurediagnosisaftertakingamedicalhistory,performingaphysicalexamandrunningsometests.Teststhataregiventodetermineheartfailureinclude:
•EKG or ECG (electrocardiogram)-measurestherateandregularityofyourheartbeat.
•Chest X-ray-willshowwhetheryourheartisenlargedoryourlungshavefluid inthem,bothsignsofheartdisease.
•BNP blood test-measuresthelevelofahormonecalledBNP(B-typenatriureticpeptide) thatisincreasedinpeoplewithheartfailure.
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Yourprimarycarephysicianmaysendyoutoacardiologist(adoctorwhospecializesinthediagnosisandtreatmentofheartdisease).He/shewillalsoperformaphysicalexamandmayordermoretests.Thereareseveralteststhatcanidentifythecauseofheartfailure.Thesetestsinclude:
•Echocardiogram-usessoundwavestocreateapictureoftheheartandshows howwelltheheartisfillingwithblood.
•Holter monitor-iswornfor24hours,providesacontinuousrecordingofheart rhythmduringnormalactivity.
•Exercise stress test-readsyourEKGandbloodpressurebefore,duringorafter exercisetoseehowyourheartrespondstoexercise.
How is Heart Failure Treated?
Heartfailurecannotbecured,buttreatingtheconditionsthatcauseditcanhelptomanagesymptoms.Treatmentincludeslifestylechangesandmedications.Treatmentforheartfailurewillhelpimprovesymptomsandstopthemfromgettingworse.Itisveryimportantthatyoufollowyourtreatmentplanbykeepingappointmentswithyourdoctor,takingmedicationsandmakinglifestylechanges.
Lifestylechangesthatyoumayneedtomakeincludelosingweight,quittingsmokingandlimitingtheamountofalcoholyoudrink.Youwillprobablyhavetofollowalow-saltdietaswell.Saltcancauseextrafluidtobuildupinyourbody,makingheartfailureworse.Yourdoctormayalsoaskyoutolimitthefluidsyoudrinkandtoweighyourselfeveryday.Ifyouhavesuddenweightgain,letyourdoctorknowrightaway.Thiscouldmeanextrafluidisbuildingup.Yourdoctormayprescribemedicationstoimproveyourheartfunctionandsymptomsincluding:
•Diuretics-reducefluidinyourlungsandswellinginyourfeetandankles.
•ACE inhibitors-lowerbloodpressureandreducestrainonyourheart.
•Angiotensin II Receptor Blockers (ARBS)-arenewerbloodpressuredrugsthatprotect yourbloodvesselsfromangiotensinII.Theymakethebloodvesselsrelaxandbecome widerandyourbloodpressuregoesdown.
•Beta blockers-slowyourheartrateandlowerbloodpressuretorelieve someoftheworkloadonyourheart.
•Digoxin-helpstheheartbeatstrongerandpumpmoreblood.
Thosewithheartfailureshouldtrytoavoidrespiratoryinfectionslikepneumoniaandtheflu.Itisrecommendedthatyougetapneumococcalvaccinetopreventpneumoniaandanannualflushottoavoidanybreathingcomplicationsfromtheflu.Yourdoctormayalsoorderextraoxygenifyouhavetroublebreathing.Theoxygencanbeusedinyourhomeorinthehospital.
Followingallofyourdoctor’srecommendationsduringadisastermaybedifficult.Itisimportantthattheybefollowedtothebestofyourabilities.Thisincludescontinuingtoweighyourselfdaily,takeallmedicationsonaconsistentscheduleandeatabalanceddiet.Failingtocontinueyourtreatmentscancauseallofyoursymptomstoreturnorgetworse.Fluidscanbuildupandcauseextrastrainonyourheart,lungsandevenyourkidneys.
High Blood Pressure
Bloodpressureistheforceofthebloodpushingagainstthewallsofthearteries.Bloodpressureisalwaysgivenastwonumbers,thesystolicanddiastolicpressures.Bothareimportant.Usuallytheyarewrittenoneaboveorbeforetheother--forexample,120/80mmHg.Thetopnumberisthesystolicandthebottomnumberisthediastolic.
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Ifyourbloodpressureis120/80,yousaythatitis“120over80.”Yourbloodpressurechangesthroughouttheday.Itislowestwhenyou’reasleepanditriseswhenyouawaken.Italsocanrisewhenyouareexcited,nervousoractive.Soitvariesthroughouttheday.
Asystolicbloodpressureof140mmHgorhigher,oradiastolicbloodpressureof90mmHgorhigher,isconsideredhighbloodpressureorhypertension.Hypertensionisthemedicaltermforhighbloodpressure.Highbloodpressurecurrentlyaffectsmorethan65millionAmericans.
What are the Symptoms of High Blood Pressure?
Highbloodpressureusuallyhasnosymptomsandisoftenreferredtoasthe“silentkiller”.Manytimes,peopleonlyfindouttheyhavehighbloodpressurewhentheyhavetroublewiththeirheart,brainorkidneys.Whenhighbloodpressureisnotdiagnosedandtreated,itcanleadtootherlife-threateningconditions,includingheartattack,strokeandkidneyfailure.Highbloodpressurecancause:
•Yourhearttoworktoohardandbecomelarger,whichcanleadtoheartfailure.
•Smallbulges(aneurysms)toforminyourbloodvessels.Commonlocationsfor aneurysmsaretheaorta,whichisthemainarteryfromtheheart;thearteriesin yourbrain,legs,andintestines;andthearteryleadingtoyourspleen.
•Bloodvesselsinyourkidneystonarrow,whichcancausekidneyfailure,and bloodvesselsinyoureyestoburstorbleed,whichmaycausevisionchanges andcanresultinblindness.
•Arteriesthroughoutyourbodyto“harden”faster,especiallythoseinyourheart, brain,kidneysandlegs.Thiscancauseaheartattack,strokeorkidneyfailure, orleadtoamputationofpartoftheleg.
What Causes High Blood Pressure?
Thereisnospecificcauseofhighbloodpressure,butthereareseveralriskfactorsthatcanmakeyoumorelikelytodevelopitincluding:
•Overweightorobese
•Amanovertheageof45orawomanovertheageof55
•Afamilyhistoryofhighbloodpressure
•Pre-hypertension,(120-139/80-89mmHg)
•Eatingtoomuchsalt
•Drinkingtoomuchalcohol
•Physicalinactivity
•Certainmedicines
•Long-lastingstress
How is High Blood Pressure Diagnosed?
Highbloodpressureisdiagnosedwhenyourdoctorchecksyourbloodpressureseveraltimesondifferentdays.Ifseveralofthereadingsare140/90mmHgorhigher(130/80mmHgorhigherifyouhavediabetesorchronickidneydisease)youhavehighbloodpressure.
How is High Blood Pressure Treated?
Normalbloodpressureislessthan120/80.Yourdoctorwilltellyouwhatyounormalrangeshouldbe.Severallifestylechangescanhelplowerbloodpressureincluding:
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•Eatinghealthyfoodsthatincludefruits,vegetablesandlow-fatmilkproducts
•Cuttingdownonsaltandsodiuminthediet
•Losingexcessweightandstayingatahealthyweight
•Beingphysicallyactivefor30minuteseachday
•Limitingalcoholintake
Lifestylechangesdon’talwayslowerbloodpressureenoughandyourdoctormayprescribemedications.Thereareavarietyofmedicationsthatyourdoctormayprescribeforyourhighbloodpressure.Somedrugslowerbloodpressurebyremovingextrafluidandsaltfromyourbody.Othersaffectbloodpressurebyslowingdowntheheartbeatorbyrelaxingandwideningbloodvessels.Often,yourdoctorwillprescribemorethanonemedication.Thetypesofmedicinesusedtotreathighbloodpressureinclude:
•Diuretics-“waterpills.”Theyworkbyhelpingyourkidneysflushexcesswater andsaltfromyourbody.Thisreducestheamountoffluidinyourbloodand yourbloodpressuregoesdown.
•Beta blockers-causeyourhearttobeatmoreslowlyandwithlessforce.Yourheart pumpslessbloodthroughthebloodvesselsandyourbloodpressuregoesdown.
•Angiotensin converting enzyme (ACE) inhibitors-keepyourbodyfrommakinga hormonecalledangiotensinII,whichnormallycausesbloodvesselstonarrow.ACE inhibitorspreventthisnarrowingsoyourbloodpressuregoesdown.
•Angiotensin II Receptor Blockers (ARBS)-arenewerbloodpressuredrugsthatprotect yourbloodvesselsfromangiotensinII.Theymakethebloodvesselsrelaxandbecome widerandyourbloodpressuregoesdown.
•Calcium channel blockers (CCBs)-keepcalciumfromenteringthemusclecellsofyourheart andbloodvessels.Thiscausesbloodvesselstorelaxandyourbloodpressuregoesdown.
•Alpha blockers-reducenerveimpulsesthattightenbloodvessels,allowingblood topassmoreeasilyandcausingbloodpressuretogodown.
•Alpha-beta blockers-reducenerveimpulsestobloodvesselsthesamewayalphablockersdo, buttheyalsoslowtheheartbeat,asbetablockersdo.Asaresult,bloodpressuregoesdown.
•Nervous system inhibitors-relaxbloodvesselsbycontrollingnerveimpulsesfromthe brain.Thiscausesbloodvesselstobecomewiderandbloodpressuretogodown.
•Vasodilators-openbloodvesselsbydirectlyrelaxingthemuscleinthevesselwalls, causingbloodpressuretogodown.
Stoppingtreatmentcanleadtoheadaches,anincreaseinbloodpressureandallofthepossiblecomplicationsduetohighbloodpressure(stroke,heartattack,heartfailure,kidneyfailure).Itisimportantthatyoutakeyourbloodpressuremedicationthesametimeeachday.Thismaybedifficulttodoinadisastersituation,buttryyourbesttokeeptoyourmedicationschedule.
Stroke
EachyearintheU.S.,therearemorethan700,000newstrokes.Strokeisthethirdleadingcauseofdeathinthecountry,afterheartdiseaseandcancer.Strokecausesmoreseriouslong-termdisabilitiesthananyotherdisease.Nearlythree-quartersofallstrokesoccurinpeopleovertheageof65.
Therearetwokindsofstroke.Themostcommonkindofstrokeiscalledischemicstroke.Itaccountsforapproximately80percentofallstrokes.Anischemicstrokeiscausedbyabloodclotthatblocksorplugsabloodvesselinthebrain.Theotherkindofstrokeiscalledhemorrhagicstroke.Ahemorrhagicstrokeiscausedbyabloodvesselthatbreaksandbleedsintothebrain.
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What are the Symptoms of Stroke?
Itisveryimportanttoknowthesignsandsymptomsofastroke.Seekingtreatmentimmediatelycanhelptolessencomplications.Ifyouobserveoneormoreofthefollowingsignsofastroke,don’twait.Calladoctoror911rightaway!
•Suddennumbnessorweaknessoftheface,arm,orleg,especiallyononesideofthebody
•Suddenconfusion,troublespeakingorunderstanding
•Suddentroubleseeinginoneorbotheyes
•Suddentroublewalking,dizziness,lossofbalanceorcoordination
•Suddensevereheadachewithnoknowncause
•Otherdangersignsthatmayoccurincludedoublevision,drowsiness,andnauseaorvomiting.
What Causes Stroke?
Therearedifferentcausesforthetwotypesofstrokes;ischemicandhemorrhagic.Ischemicstrokesarecausedby: •Theformationofaclotwithinabloodvesselofthebrainorneck,calledthrombosis
•Themovementofaclotfromanotherpartofthebody,suchasfromthehearttothe neckorbrain,calledanembolism
•Aseverenarrowingofanarteryinorleadingtothebrain,calledstenosis
Thecommoncauseofahemorrhagicstrokeisableedinganeurysm.Ananeurysmisaweakorthinspotonanarterywall.Overtime,theseweakspotsstretchorballoonoutduetohighbloodpressure.Thethinwallsoftheseballooninganeurysmscanruptureandspillbloodintothespacesurroundingbraincells.Arterywallscanalsobreakopenbecausetheybecomeencrusted,orcoveredwithfattydepositscalledplaque,eventuallylosetheirelasticityandbecomebrittle,thinandpronetocracking.Highbloodpressureincreasestheriskthatanarterywallwillgivewayandreleasebloodintothesurroundingbraintissue.
Whilefamilyhistoryofstrokeplaysaroleinyourrisk,therearemanyriskfactorsyoucancontrol:
•Getyourhighbloodpressureundercontrol.
•Ifyousmoke,quit.
•Ifyouhavediabetes,learnhowtoproperlymanageit.
•Ifyouareoverweight,startmaintainingahealthydietandexercisingregularly.
•Ifyouhavehighcholesterol,workwithyourdoctortolowerit.
How is Stroke Diagnosed?
Astrokeisdiagnosedwithavarietyofthingsincludingquestionsaboutwhenthesymptomsbeganandaneurologicalexam.Yourdoctormayalsoorderbloodtests,anelectrocardiogramandabrainscan(eitherCTorMRI).Thesescanscanhelpyourdoctordeterminewhatkindofstrokeitissothattreatmentcanbedecided.
How is Stroke Treated?
Withstroke,treatmentdependsonthestageofthedisease.Therearethreetreatmentstagesforstroke:prevention,therapyimmediatelyafterstrokeandrehabilitationafterstroke.Stroketherapiesincludemedications,surgeryandrehabilitation.
Medicationordrugtherapyisthemostcommontreatmentforstroke.Thrombolyticdrugsstopthestrokebydissolvingthebloodclotthatisblockingbloodflowtothebrainandare
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usedforischemicstrokes.Anothertypeofdrug,antithromboticsareusedtopreventstroke.Theymaybegiventosomeonewhoisathighriskofstroke,whichincludessomeonewhohasalreadyhadastroke.Antithromboticspreventtheformationofbloodclotsthatcanbecomestuckinanarteryofthebrainandcausestrokes.
Surgerycanbeusedtopreventstroke,totreatstrokeortorepairdamagetothebloodvesselsormalformationsinandaroundthebrain.
•Carotid endarterectomyisasurgicalprocedureinwhichadoctorremovesfatty deposits,orplaque,fromtheinsideofoneofthecarotidarteries.Theprocedure isperformedtopreventstroke.Thecarotidarteriesarelocatedintheneckand arethemainsuppliersofbloodtothebrain.
•EC/IC bypass surgeryisaprocedurethatrestoresbloodflowtoablood-deprived areaofbraintissue.Thesurgeonreroutesahealthyarteryinthescalptothearea ofbraintissueaffectedbyablockedartery.
•Asurgicalprocedurefortreatmentofbrainaneurysmsthatcancausehemorrhage, orbleeding,isatechniquecalledclipping.Clippinginvolvesclampingoffthe aneurysmfromthebloodvessel,whichreducesthechancethatitwillburstandbleed.
StrokeisthenumberonecauseofseriousadultdisabilityintheU.S.Thereareavarietyoftherapiesthatcanoftenhelpanindividualregainfunctioning:
•Physical therapyhelpsthestrokepatientrelearnsimplemotoractivitiessuchaswalkingsitting.
•Occupational therapyhelpspatientsrelearndailyactivitiesincludingeatinganddressing.
•Speech therapyhelpsstrokepatientsrelearnlanguageandspeakingskillsorlearn otherformsofcommunication.
•Talk Therapy,alongwiththerightmedication,helpspatientswiththepsychological problemssuchasdepression,anxiety,frustrationandangerthatarecommondisabilities inpeoplewhohavesufferedastroke.
Formanypeople,3-6monthsafterastrokeisakeytimeforrecovery.Ifyouareinthistime,itisimportantthattherapydoesnotgetinterruptedorstopped.Thismaybedifficulttodoinanemergencyordisastersituation.Ifyougotoaspecificplaceforyourrehab,arrangewithyourtherapistsanalternatelocationyoucangotoincaseofadisastersituation.Ifyoureceivetherapyathome,makearrangementswiththeagencytohavethemcometoyournewlocation(familyorfriend’shome).Ifyouhavetostayfarfromyourhome,youragencymaynotbeabletocometoyournewlocation.Askyouragencyhowfartheywilltravel.Iftheyareunabletogotoyouroutoftownlocation,askthemtoassistyouinarrangingrehabservicesinthatarea.
Early intervention in Stroke and Heart Disease
IfyoubegintosufferfromanysymptomsofstrokeorheartdiseaseSEEK MEDICAL ATTENTION IMMEDIATELY!!Oftenpeoplewaittoseeifsymptomswillgoawayontheirown.Theyoftenwanttorestforawhileorgetagoodnightsleepfirst.DO NOT WAIT.Avarietyoftreatmentoptionsareavailable,butphysicianscanonlyusethemifyouseekcare.Promptmedicaltreatmentnotonlyhelpstopreventcomplicationsfromstrokeandheartdisease,butmayalsoallowphysicianstousemedicationsandotherinterventionsinsteadofsurgery.Itmaybedifficulttoseekmedicalassistanceinadisastersituation,butpromptcareisnecessary.Ifyoubegintoexperienceanystrokeorheartrelatedsymptomstellyourfamily,friends,shelterworkers,oranyonethatcanhelpyougetthemedicalassistanceyouneed.
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Sources for Additional Heart Disease,High Blood Pressure and Stroke Information
American Heart Association http://www.americanheart.org1-800-AHA-USA-1(1-800-242-8721)
American Stroke Association http://www.strokeassociation.org1-888-4-STROKE(1-888-478-7653)
National Stroke Associationhttp://www.stroke.org1-800-STROKES(1-800-787-6537)
The National Women’s Health Information Center http://www.4women.gov/FAQ/heartdis.htm1-800-994-9662
Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/cardiovascular.htm1-502-564-7996
Free Tobacco Cessation Assistance 1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov
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�. Kidney Disease/Dialysis
Yourkidneysfilterwastefromyourblood.Thewastesfromyourbloodthatcomesfromthenormalbreakdownofactivetissuesandfromfoodyoueat.Ifyourkidneysdonotremovethesewastes,theybuildupinthebloodanddamageyourbody.Inaddition,yourkidneysalso:
•Regulateyourbodywaterandotherchemicalsinyourbloodsuchassodium, potassium,phosphorusandcalcium.
•Removedrugsandtoxinsintroducedintoyourbody.
•Releasehormonesintoyourbloodtohelpyourbody.
•Regulatebloodpressure.
•Makeredbloodcells.
•Promotestrongbones.
Kidneydiseaseresultsfromdamagetothenephrons,thetinystructuresinsideyourkidneysthatfilterblood.Usuallythedamageoccursverygraduallyoveryears.
What are the Symptoms of Kidney Disease?
Mostpeoplemaynothaveanyseveresymptomsuntiltheirkidneydiseaseisadvanced.However,youmaynoticethatyou:
•Feelmoretiredandhavelessenergy
•Havetroubleconcentrating
•Haveapoorappetite
•Havetroublesleeping
•Havemusclecrampingatnight
•Haveswollenfeetandankles
•Havepuffinessaroundyoureyes,especiallyinthemorning
•Havedry,itchyskin
•Needtourinatemoreoften,especiallyatnight
What Causes Kidney Disease?
Thetwomaincausesofchronickidneydiseasearediabetesandhighbloodpressure,whichareresponsibleforuptotwo-thirdsofthecases.
•Diabetes:Indiabetes,thebodydoesn’tuseglucose(sugar)verywell.Theglucose staysinyourbloodandactslikeapoison.Ifyouhavediabetes,youcanprevent kidneydiseasebycontrollingyourbloodsugarlevels.
•HighBloodPressure:Highbloodpressurecandamagethesmallbloodvesselsin yourkidneys.Whenthishappensyourkidneyscannotfilterwastesfromyourblood verywell.Ifyouhavehighbloodpressure(hypertension)besuretotakeanymedicines yourdoctorprescribes.
Somekidneydiseasesresultfromhereditaryfactorsandcanruninfamilies.Ifyourfamilyhasahistoryofanykindofkidneyproblems,youmaybeatriskforkidneydiseaseandshouldtalktoyourdoctor.
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How do Doctors Diagnose Kidney Disease?
Earlykidneydiseaseisasilentproblem,likehighbloodpressure,anddoesnothaveanysymptoms.Youmayhaveit,butnotknowit,becauseyoudon’tfeelsick.Todetectthediseasedoctorscandoverysimpleteststhatinclude:
•Measurethelevelofserumcreatinineinyourbloodtoestimateyourglomerular filtrationrate(GFR).
•Measurethelevelofproteininyoururine(increasedlevelsofproteinshowyour kidneysarenotworkingright).
•Checkingyourbloodpressure.
How is Kidney Disease Treated?
Kidneydiseaseoftencannotbecured.Ifyouareintheearlystagesofakidneydisease,youcantakecertainstepsthatmayhelptomakeyourkidneyslastlonger.Itisalsoimportanttoreduceyouriskfactorsforstrokeandheartattacksincekidneypatientsaresusceptibletotheseproblems.
Ifyouarediabetic,itisimportanttomonitoryourbloodsugarstokeepyourdiabetesundercontrol.Peoplewithreducedkidneyfunctionshouldhavetheirbloodpressurecontrolled,andanACEinhibitororanARBshouldbeoneoftheirmedications.Manypeoplewillrequiretwoormoretypesofmedicationtokeepthebloodpressurebelow130/80mmHg.AdiureticisanimportantadditiontotheACEinhibitororARB.
Completeandirreversiblekidneyfailureissometimescalledend-stagerenaldisease,orESRD.Ifyourkidneysstopworkingcompletely,yourbodyfillswithextrawaterandwasteproducts.Thisconditioniscalleduremia.Yourhandsorfeetmayswellandyouwillfeeltiredandweakbecauseyourbodyneedscleanbloodtofunctionproperly.Untreateduremiamayleadtoseizuresorcomaandwillultimatelyresultindeath.Ifyourkidneysstopworkingcompletely,youwillneedtoundergodialysisorkidneytransplantation.
Dialysis
Youneeddialysisifyourkidneysnolongerremoveenoughwastesandfluidfromyourbloodtokeepyouhealthy.Thisusuallyhappenswhenyouhaveonly10to15percentofyourkidneyfunctionleft.Youmayhavesymptomssuchasnausea,vomiting,swellingandfatigue.However,evenifyoudon’thavethesesymptomsyet,youcanstillhaveahighlevelofwastesinyourbloodthatmaybetoxictoyourbody.Yourdoctoristhebestpersontotellyouwhenyoushouldstartdialysis.
Therearetwomajorformsofdialysis:
•Inhemodialysis,yourbloodissentthroughamachinethatfiltersawaywasteproducts. Thecleanbloodisreturnedtoyourbody.Hemodialysisisusuallyperformedatadialysis centerthreetimesperweekfor3to4hours.
•Inperitonealdialysis,afluidisputintoyourabdomen.Thisfluid,calleddialysate, capturesthewasteproductsfromyourblood.Afterafewhours,thedialysatecontaining yourbody’swastesisdrainedaway.Then,afreshbagofdialysateisdrippedintothe abdomen.Patientscanperformperitonealdialysisthemselves.Patientsusingcontinuous ambulatoryperitonealdialysis(CAPD),themostcommonformofperitonealdialysis, changedialysatefourtimesaday.
Nomatterwhatstageofkidneydiseaseyouhave,itisimportantthattreatmentrecommendationsarefollowed,evenduringadisaster.Notfollowingtreatmentcanincreasetheriskfor
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complicationsincludingincreasedbloodpressureandassociatedcardiovascularproblems.Itcanalsodecreasekidneyfunctionleadingtoaneedfordialysisorakidneytransplant.
Medical & Dietary Information for Kidney Disease/Dialysis
Medical items/needs
Itisimportantthatyoutakeallmedicationsasprescribedanddonotinterruptorstopanytreatmentswithoutyourdoctor’sapproval.Doingsomayresultinareturnofyoursymptomsandprogressionofyourdisease.Adisasteroremergencysituationmaymakeitdifficulttocontinuewithyourtreatmentregime.Thatiswhyitissoimportanttoplanahead.Inadditiontothoselistedpreviouslyinthismanual,hereareadditionalitemsthatmaybehelpfultohaveinadisastersituation:
•WearamedicalIDbracelettoquicklyalertresponderstoyourconditionandallergies. Donotwearthebraceletonthesamesideasyourdialysisaccess.Itcouldblockblood flowifitispulledupthearm.
•HaveinstructionsforKayexalateadministration.
•Knowhowtocareforyouraccess.
•Haveacopyofyourdialysistreatmentplan(seeAdditionalResources: TreatmentInformationForm).
•Knowtheemergencypreparednessplanofyourdialysisunit.Knowhowtotake yourselfoffthemachineinanemergencyifthedialysisunitstaffareunableto. (Thedialysisunitstaffcaninstructyouonhowtodothis.)
•Makesureyourdialysisunitcaneasilycontactyouincaseofemergency.
•Hospitalsmaynotbeabletogiveyoumaintenancedialysistreatments.
•Havealternatedialysisunitsplannedincaseofdisasters.Note:Contactthealternate dialysisunitaheadoftime.Someunitsrequireadvancedregistrationfordisaster situationsbecausetheymaybeatcapacityortheymayhavedifferenthoursavailable.
•Haveasummaryofyourmedicalhistorythatincludesallofyourdialysisinformation (SeeAdditionalResources:DialysisPatientInformationForm)
If you are a home hemodialysis patient:
•Keepalistofdialysisunitsinyourareaathomeandatyourworkplace.
•Keepatwo-weekstockofdialysissuppliesatalltimes.Checkexpirationdates regularlyandreplacesupplieswhenneeded.
•Registerwithyourlocalwaterandpowercompaniesforpriorityrestorationofservice.
•Learntobecomfortabletakingyourselfoffthemachineinanemergency.
•Ifyoulosepowerwhiledialyzingduringtheemergency,followthedirections fordiscontinuingdialysisgiventoyoubyyourhometrainingstaff.
•Ifyouarenotabletocontinueyourtreatmentsathomeduringtheemergency, contactthehometrainingstaffsoalternatearrangementscanbemade.
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If you are on CAPD (continuous ambulatory peritoneal dialysis)or CCPD (continuous cycling peritoneal dialysis):
•Keepatwo-weekstockofperitonealdialysissupplies.
•Checkexpirationdatesregularlyandreplacesupplieswhenneeded. Ifyouuseanultravioletdevice,keepthebatterycharged.
•Includeinyouremergencymedicationpackafive-daysupplyoftheantibiotic thatyourdoctorordersforperitonitis.Ifadisasteroccurs,itmaybedifficultto maintainacleanenvironmentandyourriskofperitonitismaybehigher.
•Registerwithyourlocalwaterandpowercompaniesforpriorityrestorationofservice.
•IfyoudoCCPD,youshouldalsoknowhowtodoCAPDexchangesincaseyouare unabletousethecycler.
•IfyouareaCCPDpatientandyoulosepowerwhiledialyzing,followtheinstructionsgiven toyoubytheCCPDtrainingstafffordiscontinuingdialysisinanemergencysituation.
Dietary needs
Ifyouareunabletoreceiveyourscheduleddialysistreatmentduetoextremeweatheroranyotherdisaster,remembertofollowthesuggestedEmergencyDietinthisguidebookand/orchangeswhichyouhavediscussedwithyourdietitian.Besuretochoosethecorrectdietversionandgrocerylist.Includedaredietsandgrocerylistsforadults(diabeticandnon-diabetic)andoneforpediatricpatients.Thisdietisintendedtolimitthesodium,potassium,proteinandfluidloadonyourbodyintheeventthatyourtimebetweentreatmentsisextendedbeyondyourcontrol.Followingthisdietwilllessentheriskofhighbloodpressure,shortnessofbreathorincreasedpotassiumlevelsthatcouldcauseyourhearttostop.Youshouldfollowthisdietonlyfortheperiodoftimethatisnecessaryuntilyourdialysisservicescanberesumed.
Fluids: It is necessary to restrict fluids even more than before!
Takeyourphosphatebinderwiththefluidspecifiedinyourmealplan.Your2cupdailylimitallowsfor4ouncesor1/2cupoffluidinadditiontothe11/2cupsinyourmealplan.Cannedorbottledcarbonatedbeverageswillprovidemorecaloriesthanbottledwaterandoftenisabetterchoicefornon-diabetics.Chewgumtoquenchthirst.
Sodium:Avoidtablesaltandsaltsubstitutes–flavorfoodswithherbedseasoning,garlicpowderandlemonjuice.Oneeggoroneounceofmeat(cooked)thathasbeenstoredatasafetemperaturecanbesubstitutedfor1/4cupoflowsodiumcannedmeat.
Supplement Option:Ifpurchasingemergencyfoodsupplieskeepsfallingtothebottomofyour“todo”list,youmayconsiderpurchasingaconvenientspecializedliquidnutritionproducttodrinkinsteadoffollowingthesuggestedmealplan.Yourdietitiancanadviseyouofthecommerciallypreparedproductthatwillprovideloweramountsofprotein,sodium,potassiumandfluid.Thisoptionreducesconcernsforstorage,spaceandpreparation.Yourdietitiancanhelpyoutodeterminethecorrectamounttoconsumeandhowtoadjustyourotherfluidintake.
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Adult Renal Non-Diabetic Diet �-day Meal Plan for Emergencies
Thesamplemealplangivencontainsapproximately42gramsofprotein,1200mgssodium,1200mgspotassium,630mgsphosphorus,and1925caloriesperday.
Day �
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedchicken*
1tblspsugar 1tblspmargarine,oilormayonnaise*
2tblspmargarine,oilormayonnaise*
½cupdrainedpineapple ½cupgreenbeans ½cupdrainedpears
½cupcranberryjuiceordrinkfrompowderedmix
½cupcranberryjuiceordrinkfrompowderedmix
Morning Snack Afternoon Snack Evening Snack
10candies(seegrocerylist) 10marshmallows 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers
½cupapplesauce 2tblsphoneyorjelly
10candies 10candies
Day 2
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedturkey* 2ozunsaltedchicken*
1tblspsugar 1tblspmargarine,oilormayonnaise*
2tblspmargarine,oilormayonnaise*
½cupdrainedpeaches 4spearslowsodiumasparagus
½cupdrainedpineapple
½cupcranberryjuiceordrinkfrompowderedmix
½cupcranberryjuiceordrinkfrompowderedmix
Morning Snack Afternoon Snack Evening Snack
½cupapplesauce 10marshmallows 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers
10candies 10candies 2tblsphoneyorjelly
10candies
*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.
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Day �
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedturkey*
1tblspsugar 1tblspmargarine,oilormayonnaise*
2tblspmargarine,oilormayonnaise*
½cupdrainedpears 4spearslowsodiumcarrots ½cupdrainedcherries
½cupcranberryjuiceordrinkfrompowderedmix
½cupcranberryjuiceordrinkfrompowderedmix
Morning Snack Afternoon Snack Evening Snack
10marshmallows 10candies 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers
½cupapplesauce 2tblsphoneyorjelly
10candies(seegrocerylist) 10candies
*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.
Suggested Grocery List forEmergency Adult Renal Non-diabetic DietBread/cereal(Choose5-6servingsperday) WhiteBread DryCereal(sweetenedpreferred) VanillaWafers PuffedWheat GrahamCrackers PuffedRice UnsaltedCrackers(plain) CrispedRice
Fruits/juices(Choose2-4servingsperday) Cannedapplesauce,pears,peaches,cherries,orpineapple
Fish/meat(4oz.perday)Choosefrom: Cannedtuna,Chicken,Turkeyinwater
Frozenorshelfstablenon-dairycreamer(4ozperday)
Sweets Choosefrom:marshmallows,honey,sugar,jelly Assortedcandies(jellybeans,sourballs,mints,hardcandies)
Vegetables(1/2cup/day) Choosefromcanned:lowsodiumgreenbeans,asparagus,orcarrots
Fats(Choose6ormoreservingsperday) Margarine*Oil(oliveorvegetable) Mayonnaise(perishableafteropening)* *Individual mayonnaise or margarine packets are recommended to avoid spoilage
OtherBeverages(Limitto1/2cup/dayinadditiontomealplan) 1gallonofspringwater,gingeraleorlemon-limesoda Cranberryjuiceorpowderedjuicemix(Kool-Aid,Tang)
Other Herbalseasoning,garlicpowder,breathspray,chewinggum,freshorreconstitutedlemonjuice
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Adult Renal Diabetic Diet �-day Meal Plan for Emergencies
Thesamplemealplangivencontainsapproximately43gramsofprotein,1200mgssodium,1300mgspotassium,675mgsphosphorus,190gramscarbohydrate,and1700calories.Youcanadjustmenustofityourindividualtastewiththehelpofyourdietitian.Thesemealplansarestricterthanyournormalrenal-diabeticdiettokeeppoisonsfrombuildingupinyourblood.
Day �
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedchicken*
½cupdrainedpineapple(cannedinjuice)
1½tblspmargarine,oilormayonnaise*
1½tblspmargarine,oilormayonnaise*
½cuplowsodiumgreenbeans
½cupdrainedpeaches(cannedinjuice)
½cupcranberryjuice** ¼cupcranberryjuice**
Afternoon Snack Evening Snack
½cupapplesauce(sugarfree)
¼cupcranberryjuice**
5vanillawafersor3grahamcrackersor6unsaltedcrackers
1tspmargarineand1½tspjelly
Day 2
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedturkey* 2ozunsaltedchicken*
½cupdrainedpeaches(cannedinjuice)
1½tblspmargarine,oilormayonnaise*
1½tblspmargarine,oilormayonnaise*
4spearslowsodiumasparagus
½cupdrainedpears
½cupcranberryjuice** ¼cupcranberryjuice**
Afternoon Snack Evening Snack
½cupapplesauce(sugarfree)
¼cupcranberryjuice**
5vanillawafersor3grahamcrackersor6unsaltedcrackers
1tspmargarineand1½tspjelly
*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.**Low calorie cranberry juice
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Day �
Breakfast Lunch Dinner
½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread
¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedturkey*
½cupdrainedpeaches(cannedinjuice)
1½tblspmargarine,oilormayonnaise*
1½tblspmargarine,oilormayonnaise*
4spearslowsodiumcarrots ½cupdrainedcherries(cannedinjuice)
½cupcranberryjuice** ¼cupcranberryjuice**
Afternoon Snack Evening Snack
½cupapplesauce(sugarfree)
5vanillawafersor3grahamcrackersor6unsaltedcrackers
1tspmargarineand1½tspjelly
*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.**Low calorie cranberry juice
Suggested Grocery List forEmergency Adult Renal Diabetic DietBread/cereal(Choose5servingsperday) WhiteBread DryCereal(sweetenedpreferred) VanillaWafers PuffedWheat GrahamCrackers PuffedRice UnsaltedCrackers(plain) CrispedRice
Fruits(Choose3servingsperdaycannedinownjuices) Applesauce,pears,peaches,pineapple,cherries
Fish/meat(Choose4ouncesperday) CannedTunainwater CannedChickeninwater CannedTurkeyinwater
Vegetables(1servingperday) Choosefromcanned:lowsodiumasparagus,greenbeansorcarrots
Frozenorshelfstablenon-dairycreamer(4ouncesperday)
Fats(10servingsperday) Margarine**Oil(oliveorvegetable) Mayonnaise(perishableafteropening)** **Individual mayonnaise or margarine packets are recommended to avoid spoilage
HighCaloricFoods(Choose3servingsperdayandifneeded1servingtoraisebloodsugar) Honey(1Tablespoon=1serving)Jelly(1Tablespoon=1serving) Sugar(4teaspoons=1serving)LowcalorieCranberryJuice(1/2cup) PoweredDrinkMix(1/2cup,mixed)CarbonatedBeverages(1/2cup)
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OtherBeverages(Limitto1/2cup/dayinadditiontomealplan) 1gallonofSpringWater Dietlemon-limecarbonatedbeverageorDietgingeraleOther(seasoningandfluidcontrolaids) Breathspray,freshorreconstitutedlemonjuice,herbalseasoning,garlicpowder, sugarlessgum,sugarfreehardcandies(asdesired)
Adult Diabetic Menu Pattern
Breakfast Lunch Dinner
1milksubstitute(½cup) 2starches 2starches
1starch 2meats 2meats
1fruit 4½fat 4½fat
1vegetable 1fruit
1highcalorie ½highcalorie
Afternoon Snack Evening Snack
1fruit 1starch
1fat
1highcalorie
Pediatric Renal Diet �-day Meal Plan for Emergencies
Servingsizesvaryaccordingtotheageofthechild.Asalways,foodconsistencyandchokinghazardsneedtobeconsideredonanindividualbasis.Forchildrenwhostilldrinkformula,themealplanshouldbeadjustedforthechildtodrinkformulainsteadoftheotherbeverageslisted.Formulashouldbepreparedonebottleatatimeasneeded.Adjusttheamountoffoodaccordingtotheageofthechild.Forchildrenwhoarestillonformula,giveformulainsteadofjuices.Youareencouragedtodiscussportionsizesaswellasfoodpreferencesandsubstitutionswithyourrenalnutritionist.Itisnecessarytolimitfluidsevenmorethanbefore.
Day �
Breakfast Lunch Dinner
non-dairycreamer whitebread whitebread
drycereal unsaltedcannedtuna* unsaltedchicken*
sugar lowsodiummayonnaiseormargarine
lowsodiummayonnaiseormargarine
cupdrainedpineapple lowsodiumcannedgreenbeans cannedpears
Kool-AidorTang cranberryjuice
Morning Snack Afternoon Snack Bedtime Snack
candy(seeSweetslist) applesauce grahamcracker
marshmallows jelly
candy(seeSweetslist)
* If unable to keep food chilled in refrigerator after opening, keep packed in cooler with ice or snow and discard at the end of the day.
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Pediatric Renal Diet
Day 2
Breakfast Lunch Dinner
non-dairycreamer unsaltedturkeysandwich* whitebread
CreamofWheat lowsodiummayonnaiseormargarine
unsaltedchicken*
sugar lowsodiumcannedcarrots lowsodiummayonnaiseormargarine
canneddrainedpeaches Kool-AidorTang cannedcherries
cranberryjuice
Morning Snack Afternoon Snack Bedtime Snack
sugarwafers unsaltedpretzels vanillawafers
gingerale candy(seeSweetslist) candy(seeSweetslist)
Day �
Breakfast Lunch Dinner
non-dairycreamer unsaltedturkeysandwich* unsaltedturkeysandwich*
drycereal lowsodiummayonnaiseormargarine
lowsodiummayonnaiseormargarine
sugar cannedpineapple lowsodiumcannedcorn
whitebread gingerale cranberryjuice
jelly unsaltedturkeysandwich*
Morning Snack Afternoon Snack Bedtime Snack
applesauce unsaltedpretzels canneddrainedpeaches
candy(seeSweetsList) Kool-AidorTang grahamcrackers
* If unable to keep food chilled in refrigerator after opening, keep packed in cooler with ice or snow and discard at the end of the day.
Suggested Grocery List forEmergency Pediatric Renal DietBread/cereal/starches Slicedwhitebread (Maysubstitutewhiterice,noodles,spaghetti, Drycereal(sweetenedpreferred) macaroni,orunsaltedcrackersforwhitebread) Puffedrice Sugarwafers(orsugarcookies) Crispedrice Vanillawafers (CreamofWheat,CreamofRice, Grahamcrackers andFarinacanbesubstituted) Unsaltedpretzels
Fruits/juices Canned(sweetenedorinsyrup)applesauce,pears,peaches,pineappleorcherries
Fish/meat/poultryCannedunsaltedtuna,chicken,turkey(preferablysmallcans)
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Frozenorshelfstableliquidnon-dairycreamer
Sweets Marshmallows,sugar,jelly,honey,hardcandy,gumdrops,jellybeans,sourballs,mints,etc.
Vegetables Cannedlowsodiumgreenbeans,carrots,corn(Cannedmushroomsorasparagus canbesubstitutedifpreferred)
Fats Lowsodiummayonnaiseandmargarine(preferablyindividualpackets orverysmalljarstoavoidspoilage)andoil
Otherbeverages Springwater,gingerale,lemonlimesoda(nocoladrinks),cranberryjuice, Kool-Aid(nograpeflavor),Tang
Other Herbalseasonings,garlicpowder,onionpowder,breathspray,chewinggum, freshorreconstitutedlemonjuice
Formula Powderedformula(prepareonebottleatatimeasneeded)
The dietary suggestions and menu plans are from, ESRD Network 4, Inc., Emergency Preparedness Resource for Dialysis Patients (2005). Please consult your physician and/or renal nutritionist before following any of the dietary suggestions in this guidebook.
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Dialysis Patient Information Form
Date / /
PatientName: DOB / /
Address:
City: State: Zip:
Phone: SocialSecurity# / /
Neighbor or Emergency Contact:
Name:
Relationshiptoyou:
Address:
City: State: Zip:
Phone:
MedicareNumber:
OtherInsurance:
PolicyNumber:
YourDialysisCenter:
Address:
City: State: Zip:
Phone:
HeadNurse:
Nephrologist: Phone:
UsualSourceofTransportation/Needs:
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Dialysis Treatment Information Form
Ifyouneedtogotoanotherfacilityorifyourtreatmentinformationisdestroyedorunavailable,thisinformationwillhelpyourcaregiversprovideyouwiththeappropriatetreatment.Yournurseordoctorcanhelpcompletethisform.Itshouldbeupdatedaschangesoccur.
DateCompleted:
PrimaryESRDDiagnosis:
Allergies:
Medications:
PertinentPastMedicalHistory:
TypeofTreatment: CenterHemodialysis CAPD
HomeHemodialysis CCPD
DialysisPrescription
Dialyzer: Dialysate:
HoursperRun: TimesperWeek:
DryWeight: AverageWeightGain:
Heparinization:
AccessSite: NeedleSize:
BloodFlowRate:
Re-Use:Yes No Lidocaine:Yes No
HBsAgStatus: BloodType:
SpecialNeeds/Problems:
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Peritoneal Dialysis Information: CAPD
System: NumberofExchanges:
FillVolume: EstimatedDryWeight:
Exchange InformationPercentage of Dextrose (based on weight increase):
1–2lbs.1.5% 3–5lbs.3.5%
2–3lbs.2.5% 3–5lbs.4.25%
LowCalcium3.5mEq/LDianeal:
Reg.Calcium3.5mEq/LDianeal:
DianealPD2Magnesium0.5:
Peritonitis
IspatienttrainedtodoIPantibiotics?Yes No
Doespatienthaveantibioticathome?Yes No
Nameofantibiotic:
Diabetic:Yes No Insulin:IP SQ
Specifyamountinsulinused:SQDose
EveningDose
Slidingscaleforinsulin(attachifavailable):
Usual dose of insulin per bag:
1.5% 3.5%
2.5% 4.25%
AdditionalInformation:
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Peritoneal Dialysis Information: CCPD
TypeofCycler:
NightTimeTotalLitersDelivered HoursofTherapy:
FillVolumeperCycle FillTime:
DwellTime: DrainTime:
DaytimeDwell:Yes No DaytimeVolume:
Exchange InformationPercentage of Dextrose (based on weight increase):
1–2lbs.1.5% 3–5lbs.3.5%
2–3lbs.2.5% 3–5lbs.4.25%
LowCalcium3.5mEq/LDianeal:
Reg.Calcium3.5mEq/LDianeal:
DianealPD2Magnesium0.5:
PeritonitisIspatienttrainedtodoIPantibiotics?Yes No
Doespatienthaveantibioticathome?Yes No
Nameofantibiotic:
Diabetic:Yes No Insulin:IP SQ
Specifyamountinsulinused:SQDose EveningDose
Slidingscaleforinsulin(attachifavailable):
Usualdoseofinsulinperbag:
1.5% 3.5%
2.5% 4.25%
AdditionalInformation:
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Sources for Additional Kidney Disease/Dialysis Information
National Kidney Foundation of Kentucky http://www.nkfk.org/1-800-737-5433
National Kidney Disease Education Programhttp://www.nkdep.nih.gov/patients1-866-4-KIDNEY(1-866-454-3639)
ESRD Network �/�0 (Illinois, Indiana, Ohio, & Kentucky)http://www.therenalnetwork.org317-257-8265
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�. Osteoporosis, Arthritis and Bone Diseases
OsteoporosisOsteoporosisisadiseasethatthinsandweakensthebonestothepointthattheybecomefragileandbreakeasily.IntheU.S.,10millionpeoplealreadyhaveosteoporosis.Millionsmorehavelowbonemass,orosteopenia,placingthematincreasedriskformoreseriousbonelossandsubsequentfractures.Osteoporosiscanstrikeatanyage,butitismostcommonamongolderpeople,especiallyolderwomen.Ofthe10millionAmericanswithosteoporosis,80percentarewomen.
What are the Symptoms of Osteoporosis?
Osteoporosisisoftencalled“silent”becausebonelossoccurswithoutsymptoms.Peoplemaynotknowthattheyhaveosteoporosisuntilasuddenstrain,bumporfallcausesabonetobreak.Womenandmenwithosteoporosismostoftenbreakbonesinthehip,spineandwrist.Butanyfractureinanolderpersoncouldbeawarningsignthattheboneisweakerthanoptimal.
Somepeoplemaybeunawarethattheyhavealreadyexperiencedoneormorespinefractures.Heightlossofoneinchormoremaybethefirstsignthatsomeonehasexperiencedspinefracturesduetoosteoporosis.Multiplespinefracturescancauseacurvedspine,stoopedposture,backpainandbackfatigue.Womenandmenwhohavehadafractureareathighriskofexperiencinganotherone.Afractureovertheageof45orseveralfracturesbeforethatagemaybeawarningsignthatapersonhasalreadydevelopedosteoporosis.
Itisimportanttopreventfallsamongindividualswithosteoporosisbecausetheirbonesbreakeasily.Fallscanbepreventedbyhavingthepersonbeginaregularexerciseprogram,reviewingmedications,checkingvisionandmakingtheenvironmentsafer.Environmentscanbemadesaferbyremovingclutterandthingsthatcanbeeasilytrippedover,providingappropriatelightingandmakingstairsandbathroomssaferbyinstallinggrabbarsandhandrails.
What Causes Osteoporosis?
Thefollowingfactorscanputyouatriskfordevelopingosteoporosis,buttherearealsostepsyoucantaketopreventit.
•Gender.Womenareathigherriskforosteoporosisthanmen.Theyhavesmaller bonesandlosebonemorerapidlythanmendobecauseofhormonechangesthat occuraftermenopause.
•Age.Becausebonesbecomethinnerwithage,theolderyouare,thegreateryour riskofosteoporosis.
•Ethnicity.CaucasianandAsianwomenareatthehighestriskforosteoporosis. African-AmericanandHispanicwomenarealsoatrisk,butlessso.
•Family History.Osteoporosistendstoruninfamilies.Ifafamilymember hasosteoporosisorbreaksabone,thereisagreaterchancethatyouwilltoo.
•History of Previous Fracture.Peoplewhohavehadafractureareathigh riskofhavinganother. •Diet.Gettingtoolittlecalciumoveryourlifetimecanincreaseyourriskfor osteoporosis.NotgettingenoughvitaminD--eitherfromyourdiet,supplements, orsunlight--canalsoincreaseyourriskforosteoporosis.VitaminDisimportant becauseithelpsthebodyabsorbcalcium.Anoveralldietadequateinprotein andothervitaminsandmineralsisalsoessentialforbonehealth.
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•Physical activity.Notexercisingandbeinginactiveorstayinginbedforlong periodscanincreaseyourriskofdevelopingosteoporosis.Likemuscles,bones becomestrongerwithexercise.
•Smoking.Smokersmayabsorblesscalciumfromtheirdiets.Inaddition, womenwhosmokehavelowerlevelsofestrogenintheirbodies.
•Medications.Somecommonlyusedmedicinescancauselossofbonemass. Theseincludeatypeofsteroidcalledglucocorticoids,whichareusedtocontrol diseasessuchasarthritisandasthma;someantiseizuredrugs;somemedicines thattreatendometriosis;andsomecancerdrugs.Usingtoomuchthyroidhormone foranunderactivethyroidcanalsobeaproblem.Talktoyourdoctoraboutthe medicationsyouaretakingandwhatyoucandotoprotectyourbones.
•Low body weight.Womenwhoarethinandsmall-bonedareatgreater riskforosteoporosis.
How do Doctor’s Diagnose Osteoporosis?
Peopleovertheageof45whohaveexperiencedafractureshouldtalktotheirdoctoraboutgettingevaluatedforosteoporosis.Thetestusedtodiagnoseosteoporosisiscalledabonedensitytest.Thistestisameasureofhowstrongordenseyourbonesareandcanhelpyourdoctorpredictyourriskforhavingafracture.
How is Osteoporosis Treated?
Althoughthereisnocureforosteoporosis,itcanbetreated.Thegoaloftreatmentistopreventfractures.Abalanceddietrichincalcium,adequatevitaminD,aregularexerciseprogramandfallpreventionareallimportantformaintainingbonehealth.
Severalmedicationsareavailableforthetreatmentofosteoporosis.Iftreatmentisstoppedoryourdoctor’srecommendationsregardingyourosteoporosisarenotfollowed,youruntheriskoffurtherlossofbonedensityandanincreasedriskoffractures.Foryoungerpeople,afracturemaysimplyinvolvewearingacastforafewweekswhileitheals.Inolderadults,fracturescausemoreconsequences:
•Itmaytake2-3monthsforpaintoresolve.
•Withhipfractures,asmanyas50%ofpatientsdonotregaintheirpre-fracture functionafter1year.
•About25%ofwomenwillspendsometimeinanursinghomeafterahipfracture.
•About10-20%ofhipfracturepatientswilldiewithin1yearofthefracture.
ArthritisArthritisliterallymeansjointinflammation,anditcanaffectjointsinanypartofthebody.Jointsareplacesinthebodywheretwobonesmeet.Manypeopleusethetermarthritistorefertorheumaticdiseases;however,thedifferentkindsofarthritiscomprisejustaportionoftherheumaticdiseases.Manyformsofarthritiscauseswelling,redness,heatandpain.
•Osteoarthritisisthemostcommonformofarthritisamongolderpeople. Osteoarthritisoccurswhencartilage,thetissuethatcushionstheendsofthe boneswithinthejoints,breaksdownandwearsaway.Insomecases,allofthe cartilagemaywearaway,leavingbonesthatrubupagainsteachother.
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Thediseaseaffectsbothmenandwomen.Beforeage45,osteoarthritisismore commoninmenthaninwomen.Afterage45,osteoarthritisismorecommonin women.Byage65,morethanhalfofthepopulationhasx-rayevidenceofosteoarthritis inatleastonejoint.Osteoarthritisaffectsonlyjoints,notinternalorgans.
•Rheumatoid arthritisnotonlyaffectsthejoints,butmayalsoattacktissue intheskin,lungs,eyesandbloodvessels.Peoplewithrheumatoidarthritis mayfeelsick,tiredandsometimesfeverish.Rheumatoidarthritisisclassified asanautoimmunedisease.Anautoimmunediseaseoccurswhentheimmune systemturnsagainstpartsofthebodyitisdesignedtoprotect.Rheumatoid arthritisgenerallyoccursinasymmetricalpattern.Thismeansthatifoneknee orhandisinvolved,theotheroneistoo.Itcanoccuratanyage,butusually beginsduringaperson’smostproductiveyears.Rheumatoidarthritisoccurs muchmorefrequentlyinwomenthaninmen.Abouttwotothreetimesas manywomenasmenhavethedisease.
What are the Symptoms of Arthritis?
Differenttypesofarthritishavedifferentsymptoms.Ingeneral,peoplewithmostformsofarthritishavepainandstiffnessintheirjoints.
Osteoarthritisusuallydevelopsslowlyandcanoccurinanyjoint,butoftenoccursinweightbearingjoints.Othersymptomsinclude:
•Jointsmayacheafterphysicalworkorexercise
•Mostoftenoccursinthehands,hips,knees,neckorlowback
•Jointpain,swellingandtenderness
•Stiffnessaftergettingoutofbed
•Acrunchingfeelingorsoundofbonerubbingonbone
Noteveryonewithosteoarthritisfeelspain,however.Infact,onlyathirdofpeoplewithx-rayevidenceofosteoarthritisreportpainorothersymptoms.
Rheumatoidarthritisischaracterizedbyinflammationofthejointlining.Thisinflammationcauseswarmth,redness,swellingandpainaroundthejoints.Apersonalsofeelssick,tiredandsometimesfeverish.Rheumatoidarthritisgenerallyoccursinasymmetricalpattern.Ifonekneeorhandisaffected,theotheroneisalsolikelytobeaffected.
What Causes Arthritis?
Thecausesofarthritisarenotfullyunderstood.Researcherssuspectthatosteoarthritisiscausedbyacombinationoffactorsinthebodyandtheenvironment.Thechanceofdevelopingosteoarthritisincreaseswithage.Osteoarthritisoftenresultsfromyearsofwearandtearonjoints.Thiswearandtearmostlyaffectsthecartilage,thetissuethatcushionstheendsofboneswithinthejoint.Osteoarthritisoccurswhenthecartilagebeginstofray,wearawayanddecay.Puttingtoomuchstressonajointthathasbeenpreviouslyinjured,improperalignmentofjoints,andexcessweightallmayleadtothedevelopmentofosteoarthritis.
Rheumatoidarthritisresultsfromtheinteractionofmanyfactorssuchasgenes,hormonesandtheenvironment.Researchsuggeststhataperson’sgeneticmakeupisanimportantpartofthepicture,butnotthewholestory.Someevidenceshowsthatinfectiousagents,suchasvirusesandbacteria,maytriggerrheumatoidarthritisinpeoplewithaninheritedtendencytodevelopthedisease.However,aspecificagentoragentsarenotyetknown.
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How do Doctors Diagnose Arthritis?
Tomakeadiagnosis,mostdoctorsuseacombinationofmethodsandtestsincludingacompletemedicalhistory,aphysicalexaminationx-raysandlaboratorytests.Rheumatoidarthritiscanbedifficulttodiagnoseinitsearlystagesforseveralreasons.First,thereisnosingletestforthedisease.Inaddition,symptomsdifferfrompersontopersonandcanbemoresevereinsomepeoplethaninothers.Also,symptomsofrheumatoidarthritiscanbesimilartothoseofothertypesofarthritisandjointconditions,anditmaytakesometimetoruleoutotherconditions.Finally,thefullrangeofsymptomsdevelopsovertime,andonlyafewsymptomsmaybepresentintheearlystages.
How is Arthritis Treated?
Althoughthereisnocureformostformsofarthritis,varioustherapiescanhelppatientsmanagesymptomsandimprovetheiroverallqualityoflife.
OsteoarthritisOsteoarthritistreatmentplansoftenincludewaystomanagepainandimprovefunction.Currenttreatmentsforosteoarthritiscanrelievesymptomssuchaspainanddisability,butrightnowtherearenotreatmentsthatcancureosteoarthritis.
•Exercise-candecreasepain,increaseflexibilityandhelpyoumaintainahealthy weight.Theamountandformofexercisewilldependonwhichjointsareinvolved, howstablethejointsare,whetherornotthejointisswollenandwhetherajoint replacementhasalreadybeendone.
•Heat or ice-youcanusewarmtowels,hotpacksorawarmbathorshower.In somecases,coldpackssuchasabagoficeorfrozenvegetableswrappedinatowel canrelievepainornumbthesorearea.Adoctororphysicaltherapistcanrecommend ifheatorcoldisthebesttreatment.Forosteoarthritisintheknee,wearinginsolesor cushionedshoesmayreducejointstress.
•Medications-doctorsusuallystartwithacetaminophenbecausethesideeffectsare minimal,thennon-steroidalanti-inflammatorydrugssuchasibuprofenandnaproxen maybeused.Corticosteroids,hyaluronicacidandtopicalcreamsarealsoused.
•Protection and support of joints-somepeopleusecanesandsplintstoprotect andtotakepressureoffthejoints.Splintsorbracesareusedtoprovideextrasupport forweakenedjoints.
•Surgery-helpsrelievethepainanddisabilityofosteoarthritis.Adoctormayperform surgerytosmoothout,fuse,orrepositionbonesortoreplacejoints.
Rheumatoid Arthritis
Treatmentsforrheumatoidarthritiscanhelprelieveyourpain,reduceswelling,slowdownorhelppreventjointdamage,increaseyourabilitytofunctionandimproveyoursenseofwell-being.Exercise,medication,andinsomecases,surgeryarecommontreatmentsforrheumatoidarthritis.Peoplewithrheumatoidarthritisneedagoodbalancebetweenrestandexercise;theyshouldrestmorewhenthediseaseisactiveandexercisemorewhenitisnot.
Anoverallnutritiousdietwiththerightamountofcalories,proteinandcalciumisimportant.Somepeopleneedtobecarefulaboutdrinkingalcoholicbeveragesbecauseofthemedicationstheytakeforrheumatoidarthritis.Reducingstressalsoisimportant.Doingrelaxationexercisesandtakingpartinsupportgroupsaretwowaystohelpreducestress.
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Mostpeoplewhohaverheumatoidarthritistakemedications.Somedrugsonlyprovidereliefforpain,othersreduceinflammation.Stillothers,calleddisease-modifyinganti-rheumaticdrugsorDMARDs,canoftenslowthecourseofthedisease.Steroids,whicharealsocalledcorticosteroids,areanothertypeofdrugusedtoreduceinflammationforpeoplewithrheumatoidarthritis.Earlytreatmentwithpowerfuldrugsanddrugcombinationsinsteadofsingledrugsmayhelppreventthediseasefromprogressingandgreatlyreducejointdamage.
Insomecases,adoctorwillrecommendsurgerytorestorefunctionorrelievepaininadamagedjoint.Surgerymayalsoimproveaperson’sabilitytoperformdailyactivities.Jointreplacementandtendonreconstructionaretwotypesofsurgeryavailabletopatientswithseverejointdamage.
Nomatterwhattypeofarthritisyouhave,thegoaloftreatmentistoreducepainandimprovedailyfunctioning.Itisimportantthattreatmentrecommendationsbefollowed.Thismaybedifficulttodoinadisastersituation,butfollowingyourtreatmentplancangoalongwayinmaintainingyourqualityoflife.
Sources for Additional Osteoporosis,Arthritis and Bone Disease InformationOsteoporosis
National Osteoporosis Foundation http://www.nof.org1-800-231-4222
Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/osteo.htm
National Women’s Health Information Center http://www.4women.gov/FAQ/osteopor.htm1-800-994-9962
ArthritisArthritis Foundation http://www.arthritis.org/arthritis-is.php1-800-283-7800
Arthritis Foundation Ohio River Valley Chapter http://ww2.arthritis.org/communities/chapters/Chapter.asp?Chapid=651-800-383-6843
Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/arthritis.htm
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�. Parkinson’s Disease, Alzheimer’s Disease and Other Neurological Disorders
Parkinson’s DiseaseParkinson’sdiseaseisamovementdisorderthatimpairsmotorskills,speechandotherfunctions.AsmanyasonemillionAmericanssufferfromParkinson’sdisease.Whileapproximately15percentofpeoplewithParkinson’sarediagnosedbeforetheageof50,incidenceincreaseswithage.
What are the Symptoms of Parkinson’s Disease?
ItisimportanttorealizethatnoteverypersonwithParkinson’sdevelopsallsignsorsymptomsofthedisease.Forexample,somepeopleexperiencetremorastheprimarysymptom,whileothersmaynothavetremorbutdohavebalanceproblems.Also,forsomepeoplethediseaseprogressesquickly,andinothersitdoesnot.ThefollowingaredescriptionsofthemostcommonprimarysymptomsofParkinson’sdisease:
•Slighttremorinthehandorfootononesideofthebody,orlesscommonly inthejaworface.
•Stiffnessorinflexibilityofthemusclesalsocalledrigidity.Rigiditycancause pain,crampingandadecreasedrangeofmotion.
•Slowingofmovementsisalsocalledbradykinesia.Peoplewhohavebradykinesia maywalkwithshort,shufflingsteps.
•Impaired balance and coordination:PeoplewithParkinson’sdiseaseoftenexperience instabilitywhenstandingorimpairedbalanceandcoordination.Peoplewithbalance problemsmayhavedifficultymakingturnsorabruptmovements.Theymaygothrough periodsof“freezing,”whichiswhenapersonfeelsstucktothegroundandfindsit difficulttostartwalking.
ThefollowingisalistofsecondarysymptomsofParkinson’sdisease:
•Speechchanges •Depression •Small,crampedhandwriting •Fearoranxiety •Lossoffacialexpressionor“masking” •Memorydifficultiesandslowedthinking •Difficultyswallowing •Sexualdysfunction •Drooling •Urinaryproblems •Pain •Fatigueandaching •Dementiaorconfusion •Lossofenergy •Sleepdisturbances •Compulsivebehavior •Constipation •Cramping •Skinproblems
What Causes Parkinson’s?
ThecauseofParkinson’sdiseaseisunknown.Itisknownthatitaffectscellscalledneuronsthatarelocatedinasmallareaatthebaseofthebraincalledthesubstantianigra.Theseneuronsnormallymakeachemicalcalleddopamine.Dopamineisoneofthechemicalsneededtohelpthebrainfunctionsmoothlyandcontrolmovementofthebody.Dopaminehelpsnerveimpulsestotransmitmessagestomuscles,resultinginwhatweknowasnormalbodymovement.
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Parkinson’sdiseaseresultswhenneuronsdieandlessdopamineismade.Whenthesupplyofdopamineisdecreasedbyapproximately50%-60%,symptomsofParkinson’sbegintostart.Overtime,asmoreneuronsarelostandthesupplyofdopamineislowerandlower,symptomsbecomemoresevere.ThecauseofthecelldeaththatleadstoParkinson’sdiseaseisunknown.
How do Doctors Diagnose Parkinson’s?
AnaccuratediagnosisofParkinson’sdiseasecanbedifficulttomake.Today,thereisnospecificdiagnostictestthatcanbeusedtoconfirmthedisease.However,anMRIscanorbloodtestscanbeusedtoruleoutotherdisordersthathavesomesymptomssimilartoParkinson’s.Diagnosisismadebyaphysicianbasedonaphysicalexaminationofthepatient,focusedonthebodymovementsymptomsthatareassociatedwithParkinson’s,alongwiththepatient’smedicalhistory.
How is Parkinson’s Treated?
Parkinson’sismainlytreatedwithmedications.Iftheydonotwork,sometimessurgeryhelpssomesymptoms.Thegoaloftreatmentistobalancethechemicalsdopamineandacetylcholinefoundinthebrain.Averycommonmedicationislevodopa,orL-dopa.Itisachemicalthebrainneedstomakedopamine.Itbreaksdownveryquicklyinthebrain,andpatientsoftentakeothermedicationstopreventthis.Othermedicationsaregiventhatactjustlikedopamineinthebrainandsomecounteractacetylcholine.Mostmedicationsusuallyworkwellatfirst.Overtime,dosesandcombinationsofmedicationsmayneedtobechangedforbestresults.
Parkinson’smedicationsdohavesideeffectsincludingnausea,depression,drymouthandblurredvision.Afterapatienthasbeentakingmedicationsforawhile,heorshemightstarttohavejerkymovementsinthefaceorarms.Thisiscalleddyskinesia.Themedicationscanalsomakeapersongofromhavinggoodmobilitytoalmostnomobility.Thisiscalled“on-offphenomena”
Physicalandoccupationaltherapycanhelpwithposture,walkingandfinemovements.Sometimeschangingmedicationcombinationsordosagesmakessymptomsbetter.Ifmedicationsdonothelp,surgerymaybeanoption.SurgeryforParkinson’seitherdestroysorstimulatespartsofthebrain.
Itisverydangeroustostoporchangemedicationswithoutdiscussingitwithyourdoctor.Interruptingtheprescribedtreatmentschedulecancauseaworseningofsymptoms,andpossiblynewones.Thesymptomscanleadtoadecreaseinfunctioning.Itmaybedifficulttokeeptoyourdosingscheduleduringadisaster,butitisimportanttodosoinordertomanageyoursymptomsandmaintainyourqualityoflife.
Alzheimer’s Disease Alzheimer’sdiseaseisatypeofdementia,whichcausesnervecellsinthebraintodie.Thediseaseaffectsmemory,thinking,personalityandbehavior.Scientiststhinkthatupto4.5millionpeopleintheU.S.sufferfromAlzheimer’sdisease.Thediseaseusuallybeginsafterage65andriskgoesupwithage.WhileyoungerpeoplealsomaygetAlzheimer’sdisease,itismuchlesscommon.About5percentofmenandwomenages65to74haveAlzheimer’sdisease,andnearlyhalfofthoseage85andoldermayhavethedisease.Itisimportanttonote,however,thatAlzheimer’sdiseaseisnotanormalpartofaging.
What are the Symptoms of Alzheimer’s?
Alzheimer’sdiseasebeginsslowly.Atfirst,theonlysymptommaybemildforgetfulness.PeopleintheearlystagesofAlzheimer’sdiseasemayhavetroublerememberingrecentevents,activities,orthenamesoffamiliarpeopleorthings.Simplemathproblemsmaybecomehardtosolve.Suchdifficultiesmaybeabother,butusuallytheyarenotseriousenoughtocausealarm.
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However,inthemiddlestages,forgetfulnessbeginstointerferewithdailyactivities.Peoplemayforgetthewayhomeorfindithardtocopewithdailylife.SuchsymptomsaremoreeasilynoticedandbecomeseriousenoughtocausepeoplewithAlzheimer’sdiseaseortheirfamilymemberstoseekmedicalhelp.
PeopleinthelaterstagesofAlzheimer’sdiseasemayforgethowtodobasictasks,likebrushingtheirteethorcombingtheirhair.Theycannolongerthinkclearly.Theybegintohaveproblemsspeaking,understanding,readingorwriting.Lateron,peoplewithAlzheimer’sdiseasemaybecomeanxious,agitatedoraggressiveorwanderawayfromhome.Eventually,patientsneedtotalcare.
What Causes Alzheimer’s?
ScientistsdonotyetfullyunderstandwhatcausesAlzheimer’sdisease,buttheyhavefoundbrainchangesinpeoplewiththedisease.Whatcausesthechangesisstillunknown.Thereprobablyisnotonesinglecause,butseveralfactorsthataffecteachpersondifferently.
•Age-themostimportantknownriskfactorforAlzheimer’sdisease.Thenumber ofpeoplewiththediseasedoublesevery5yearsbeyondage65.
•Family history-Scientistsbelievethatgeneticsmayplayaroleinthecausesof Alzheimer’sdisease.Forexample,early-onsetfamilialAlzheimer’sdisease,arare formofAlzheimer’sdiseasethatoccursbetweentheagesof30and60,isinherited.
•Other risk factors-likehighbloodpressure,highcholesterolandlowlevelsof thevitaminfolate–mayalsoincreasetheriskofAlzheimer’s.
Researchersarealsoinvestigatingthepossibilitythatphysical,mentalandsocialactivitiesmayprotectagainstAlzheimer’s.
How do Doctors Diagnose Alzheimer’s?
DoctorsuseseveraltoolstodiagnoseAlzheimer’sdisease:
•Acompletemedicalhistoryincludingquestionsaboutanydifficultiescarrying outdailyactivities
•Medicaltests,suchastestsofblood,urineorspinalfluid
•Teststomeasurememory,problemsolving,attention,countingandlanguage
•Brainscansthatallowthedoctortolookatapictureofthebraintoseeif anythingdoesnotlooknormal
Sometimes,thesetestresultshelpthedoctorfindotherpossiblecausesoftheperson’ssymptoms.Forexample,thyroidproblems,drugreactions,depression,braintumorsandbloodvesseldiseaseinthebraincancausesymptomssimilartothoseofAlzheimer’s.Someoftheseotherconditionscanbetreatedsuccessfully.
How is Alzheimer’s Treated?
ThereisnoknowncureforAlzheimer’s,buttherearetreatmentsthatcanpreventsomesymptomsfromgettingworseforalimitedtime.Forsomepeopleintheearlyandmiddlestagesofthedisease,therearedrugsthatmayhelppreventsomesymptomsfrombecomingworseforalimitedtime.Also,somemedicinesmayhelpcontrolbehavioralsymptomsofAlzheimer’sdiseasesuchassleeplessness,agitation,wandering,anxietyanddepression.Treatingthesesymptomsoftenmakespatientsmorecomfortableandmakestheircareeasierforcaregivers.
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FamilymembersandfriendscanassistpeopleintheearlystagesofAlzheimer’sincontinuingtheirdailyroutines,physicalactivities,andsocialcontacts.PeoplewithAlzheimer’sshouldbekeptup-to-dateaboutthedetailsoftheirlives,suchasthetimeofday,wheretheyliveandwhatishappeningathomeorintheworld.Memoryaidsmayhelpintheday-to-daylivingofpatientsintheearlierstagesofAlzheimer’s.Somefamiliesfindthatabigcalendar,alistofdailyplans,notesaboutsimplesafetymeasuresandwrittendirectionsdescribinghowtousecommonhouseholditemsareveryusefulaids.
Alzheimer’s Disease (additional information)
•Extraidentificationitemssuchasclothingtags,walletcardsorIDjewelry (bracelets,necklace,dogtags,etc.)
•ConsiderenrollingyourlovedoneintheAlzheimer’sSafeReturn®program.
•Arecentphotoofyourlovedoneincasehe/shewandersawayinthecommotion.
•Apillow,toyorsomethingelsetohug
•Lotionorotheritemsthatcanhelpsootheanagitatedindividual
•Makesureothercareattendantsthathelpyoualsohavecopiesofyourloved one’sdementiamedicalhistory,physicianinformation,andfamilycontacts.
•SeeSection3:DementiaandMemoryLossformoreinformationaboutcaring foralovedonewithdementiainadisastersituation.
Multiple Sclerosis (MS)MultipleSclerosis(MS)isadiseasethataffectsthebrainandspinalcord.Manydifferentareasofthebrainandspinalcordmaybeinvolved.Patchesoftheareasofthebrainandspinalcordaffectedbecomehardened(sclerosed)withscartissue.Anormalnervefiberissurroundedbyafattysubstancecalledmyelin,whichislikeinsulationprotectingelectricalwires.Myelinhelpsmessagestravelsmoothlyalongthenervefiber.Whenmyelinbreaksdown,scartissueformswhichpreventsmessagesfromflowingsmoothlyalongthenerve.Messagescanbecomecompletelyblockedandbodyfunctionssuchasspeaking,movingandseeingareaffected.
What are the Symptoms of MS?
Thesymptomsvarydependingontheareawherethescarpatchesoccur.Symptomsmayoccurinanycombination,andmaybemildtosevere,including:
•Poorbalance •Forgetfulnessorconfusion •Poorcoordination •Numbnessortinglyfeelings •Moodswings like“pinsandneedles” •Shakingofthehand(s) •Involuntary(uncontrolled) •Unusualfatigue rapidmovementsoftheeyes •Doubleorblurryvision •Weaknessofanarmorleg, •Slurredspeech whichmayleadtoparalysis •Musclecrampsorspasms orinabilitytomoveifthe •Difficultywalking diseaseissevere
What Causes MS?
ThecauseofMSisnotknown.TherearemanytheoriesincludingthatMSmaybeanauto-immunereaction.OnetheoryisthatMSmaybecausedbyavirusthatstaysinthebodyformonthsoryearsbeforesymptomsappear.AnothertheoryisthatMSmaybecausedbyacombinationofviralinfectionandimmunereaction.Thevirustakesoverbodycells.Theimmunesystemthenattacksthesecellsorthewallofthevirus.
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How is MS Diagnosed?
DiagnosingMSmaybeeasyinsomecasesanddifficultinothersbecauseearlysymptomscanbemildandgoawaywithouttreatment.Symptomsmaynotreappearforweeks,monthsoryears.MSmayhavethesamesymptomsasotherdiseasesandthereisnosingletestthatgivesadefinitediagnosis.TofindoutifapersonhasMS,thedoctorwillordercertaintests.However,thediagnosisofMSisalwaysmadebythehistoryandphysicalexam.
How is MS Treated?
ThereisnocureforMS.However,personswithMScanhaveasatisfactory,productivelifeevenwithlimitations.MSisnotafataldisease,butapersonwithMSmaybemorelikelytogetarespiratoryorurinarytractinfection.Iftheseinfectionsarenottreated,theycancausedeath.Youcaneasesymptomsby:
•Leadingahealthylifestyle
•Avoidingextremesofheatandcold
•Participatinginphysicaltherapywhichprovidesexerciseprogramsandmuscleretraining
•Takingmedicationsthatmayhelpcontrolsymptomsordecreasethefrequency,duration orintensityofattacks
ALS (Lou Gehrig’s Disease)Amyotrophiclateralsclerosis(ALS),oftenreferredtoas“LouGehrig’sdisease,”isaprogressiveneurodegenerativediseasethataffectsnervecellsinthebrainandthespinalcord.Motorneuronsreachfromthebraintothespinalcordandfromthespinalcordtothemusclesthroughoutthebody.TheprogressivedegenerationofthemotorneuronsinALSeventuallyleadtotheirdeath.Whenthemotorneuronsdie,theabilityofthebraintoinitiateandcontrolmusclemovementislost.Withvoluntarymuscleactionprogressivelyaffected,patientsinthelaterstagesofthediseasemaybecometotallyparalyzed.
What are the Symptoms of ALS?
AttheonsetofALSthesymptomsmaybesoslightthattheyarefrequentlyoverlooked.Withregardtotheappearanceofsymptomsandtheprogressionoftheillness,thecourseofthediseasemayincludethefollowing:
•muscleweaknessinoneormoreofthefollowing:hands,arms,legsorthemuscles ofspeech,swallowingorbreathing
•twitching(fasciculation)andcrampingofmuscles,especiallythoseinthehandsandfeet
•impairmentoftheuseofthearmsandlegs
•“thickspeech”anddifficultyinprojectingthevoice
•inmoreadvancedstages,shortnessofbreath,difficultyinbreathingandswallowing
What Causes ALS?
A-myo-trophiccomesfromtheGreeklanguage.“A”meansnoornegative.“Myo”referstomuscle,and“Trophic”meansnourishment–”Nomusclenourishment.”Whenamusclehasnonourishment,it“atrophies”orwastesaway.“Lateral”identifiestheareasinaperson’sspinalcordwhereportionsofthenervecellsthatsignalandcontrolthemusclesarelocated.Asthisareadegeneratesitleadstoscarringorhardening(“sclerosis”)intheregion.
Asmotorneuronsdegenerate,theycannolongersendimpulsestothemusclefibersthatnormallyresultinmusclemovement.EarlysymptomsofALSoftenincludeincreasingmuscleweakness,
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especiallyinvolvingthearmsandlegs,speech,swallowingorbreathing.Whenmusclesnolongerreceivethemessagesfromthemotorneuronsthattheyrequiretofunction,themusclesbegintoatrophy(becomesmaller).Limbsbegintolook“thinner”asmuscletissueatrophies.
How do Doctors Diagnose ALS?
ALSisaverydifficultdiseasetodiagnose.Todate,thereisnoonetestorproceduretoultimatelyestablishthediagnosisofALS.Itisthroughaclinicalexaminationandseriesofdiagnostictests,oftenrulingoutotherdiseasesthatmimicALS,thatadiagnosiscanbeestablished.Acomprehensivediagnosticworkupincludesmost,ifnotall,ofthefollowingprocedures:
•Electrodiagnostictestsincludingelectomyography(EMG)andnerveconductionvelocity(NCV)
•Bloodandurinestudiesincludinghighresolutionserumproteinelectrophoresis,thyroid andparathyroidhormonelevelsand24hoururinecollectionforheavymetals
•Spinaltap
•X-rays,includingmagneticresonanceimaging(MRI)
•Myelogramofcervicalspine
•Muscleand/ornervebiopsy
•Thoroughneurologicalexamination
How is ALS Treated?
WhilethereisnotacureortreatmenttodaythathaltsorreversesALS,therearetherapiesthatcanmanagethesymptomsofALSthathelppeoplemaintainasmuchindependenceaspossibleandprolongsurvival.ItisimportanttorememberthatALSisaquitevariabledisease;notwopeoplewillhavethesamejourneyorexperiences.TherearemedicallydocumentedcasesofpeopleinwhomALS‘burnsout,’stopsprogressingorprogressesataveryslowrate.Nomatterwhatyourindividualcourseorsituationmaybethereareresourcesthatcanhelp.
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Sources for Additional Parkinson’s Disease, Alzheimer’sDisease and Other Neurological Disorders Information
Parkinson’s DiseaseNational Parkinson’s Foundationhttp://www.parkinson.org1-800-327-4545
Parkinson’s disease Foundation http://www.pdf.org1-800-457-6676
Kentucky Parkinson’s Disease Information and Referral Center http://ukhealthcare.uky.edu/KNIapda_parkinsons.htm1-866-554-APDA(2732)
Multiple SclerosisNational MS Societyhttp://www.nationalmssociety.org1-800-344-4867
ALS (Lou Gehrig’s Disease)http://www.alsa.org/1-818-880-9007
Alzheimer’s DiseaseAlzheimer’s Association http://www.alz.org1-800-272-3900
Alzheimer’s Association Safe Returnhttp://www.alz.org/safereturn1-888-572-8566
National Institute on Aging Alzheimer’sDisease Education and Referral (ADEAR)http://www.alzheimers.nia.nih.gov1-800-438-4380
Family Caregiver Alliance http://www.caregiver.org1-800-445-8106
Children of Aging Parentshttp://www.caps4caregivers.org1-800-227-7294
Eldercare Locatorhttp://www.eldercare.gov1-800-677-1116
Well Spouse Associationhttp://www.wellspouse.org1-800-838-0879